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NeoReviews Vol.6 No.2 2005 e87
© 2005 American Academy of Pediatrics

Gastroesophageal Reflux in the Preterm Neonate

Sudarshan R. Jadcherla, MD, FRCPI, DCH^*
Colin D. Rudolph, MD, PhD

^* Associate Professor of Pediatrics, Section of Neonatology, Pediatric Gastroenterology and Nutrition, Columbus Children’s Hospital, The Ohio State University College of Medicine and Public Health, Columbus, Ohio
Director and Chief of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Wisconsin, Milwaukee, Wis

The first 300 words of the full text of this article appear below.

	Objectives

 
After completing this article, readers should be able to:

1. Describe the epidemiology and pathophysiology of gastroesophageal reflux (GER) in preterm neonates.
   
2. Delineate the associations of GER with apnea, chronic lung disease, behavior, and growth of preterm infants.
   
3. Review the investigations used to evaluate GER in preterm infants.
   
4. Describe nonpharmacologic and pharmacologic therapies for GER.
   

	Introduction

 
Gastroesophageal reflux (GER) is a normal physiologic event occurring across the age spectrum. It may contribute to a variety of disorders, including esophagitis, feeding problems, and airway disease in all age groups. (1) A large number of symptoms and signs have been purported to be caused by GER despite a lack of data showing a clear association between a specific symptom and GER. In preterm infants, empiric therapy often is administered using agents of unproven efficacy and safety to treat symptoms that likely are unrelated to GER. In a survey on management practices for GER in preterm infants, common treatment strategies included positioning (98%) and slopes (96%), histamine ₂ (H ₂) receptor antagonists (100%), feed thickeners (98%), antacids (96%), prokinetics (79%), proton pump inhibitors (PPIs) (65%), and dopamine receptor antagonists (53%). (2)(3) The safety, efficacy, and appropriate dosing recommendations for most medical therapies remain uncertain in neonates. In this review, we attempt to summarize the current literature regarding physiology, pathophysiology, and diagnostic and management strategies for GER pertinent to the neonate, with an emphasis on the preterm infant.

	Definitions

 
GER describes the retrograde movement of stomach contents (air or feeding, liquid or semisolid, acid or alkaline, enzymes or bile salts) into the esophagus. GER disease (GERD) occurs when GER causes symptoms or signs such as pain, poor weight gain, esophagitis, hematemesis, and airway symptoms, including apnea, aspiration, recurrent pneumonia, chronic lung disease (CLD), or large airway inflammation. However, any of these symptoms . . . [Full Text of this Article]

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