This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
- AAP:
- American Academy of Pediatrics
- BPD:
- bronchopulmonary dysplasia
- CMPA:
- cow milk protein allergy
- GEJ:
- gastroesophageal junction
- GER:
- gastroesophageal reflux
- GERD:
- gastroesophageal reflux disease
- H2RA:
- histamine 2 receptor antagonist
- LES:
- lower esophageal sphincter
- NASPGHAN:
- North American Society of Pediatric Gastroenterology, Hepatology and Nutrition
- pH-MII:
- multichannel intraluminal pH impedance
- PPI:
- proton pump inhibitor
- SLESR:
- swallow-associated lower esophageal sphincter relaxation
- SSI:
- symptom sensitivity index
- TLESR:
- transient lower esophageal sphincter relaxation
- VLBW:
- very low-birthweight
Education Gap
Clinicians caring for premature infants need to recognize the natural history and pathophysiology of gastroesophageal reflux (GER) and GER disease. Clinicians also need to make the most out of the diagnostic tools available in their clinical settings and offer the most appropriate therapy for these conditions, which constitute a significant burden to patients and to our health care system.
Objectives
After completing this article, readers should be able to:
Explain the terminology, mechanisms, and controversies surrounding gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in neonates.
Describe the epidemiology, pathophysiology, and risk factors of GER and GERD in neonates.
Explain the approach to evaluate, diagnose, and manage GERD in neonates.
Introduction
Gastroesophageal reflux (GER) is a normal physiologic process that occurs in all age groups. In healthy preterm infants, an average of 2 to 3 reflux events occur per hour, as has been reported using 24-hour pH impedance monitoring. (1) GER has historically been associated with a wide variety of behaviors commonly attributed to “GERD-like” symptoms in infants. (2) However, the association between a specific symptom and GER needs supporting data. (3) In the NICU infant, many of these symptoms may have multisystemic etiologies related to prematurity, chronic lung disease, and neuropathology, among others, rather than solely GER.
Over the years, GER has remained a controversial topic for clinicians because of the challenges that entail its accurate diagnosis, as well as the uncertainty of treatment efficacy in symptomatic neonates. Furthermore, various studies have shown that histamine 2 receptor antagonists (H2RAs), proton pump inhibitors (PPIs), and prokinetics therapy may be associated with serious adverse outcomes in preterm infants. (4)(5)(6)(7) In addition, the American Academy of Pediatrics (AAP) through the “Choosing Wisely in Newborn Medicine” initiative highlighted routine use of antireflux medications in symptomatic GER in preterm infants …
Individual Login
Institutional Login
You may be able to gain access using your login credentials for your institution. Contact your librarian or administrator if you do not have a username and password.
Log in through your institution
Purchase access
In this issue
Jump to section
- Article
- Education Gap
- Objectives
- Introduction
- Definitions
- Epidemiology of GERD in Preterm Infants
- Physiology of GER in Infants
- Pathophysiology of GERD in Neonates
- GER Risk Factors in Infants
- Clinical Manifestations of GER in Infants
- Diagnostic Approach for GERD Evaluation in Infants
- Management of GERD in Infants
- Recent Advances to Address Controversies in GERD Pathophysiology and Management
- Conclusions
- Acknowledgment
- Footnotes
- References
- Figures & Data
- Info & Metrics
- Comments
Related Articles
Cited By...
- No citing articles found.