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American Academy of Pediatrics
Article

Gastroesophageal Reflux Disease in Neonates: Facts and Figures

Jenny Bellodas Sanchez and Sudarshan R. Jadcherla
NeoReviews February 2021, 22 (2) e104-e117; DOI: https://doi.org/10.1542/neo.22-2-e104
Jenny Bellodas Sanchez
*Innovative Neonatal and Infant Feeding Disorders Research Program, Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
†Division of Neonatology, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH
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Sudarshan R. Jadcherla
*Innovative Neonatal and Infant Feeding Disorders Research Program, Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
†Division of Neonatology, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH
‡Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
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  • Abbreviations:
    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:

    1. Explain the terminology, mechanisms, and controversies surrounding gastroesophageal reflux (GER) and gastroesophageal reflux disease (GERD) in neonates.

    2. Describe the epidemiology, pathophysiology, and risk factors of GER and GERD in neonates.

    3. 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 …

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    NeoReviews
    Vol. 22, Issue 2
    1 Feb 2021
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    Gastroesophageal Reflux Disease in Neonates: Facts and Figures
    Jenny Bellodas Sanchez, Sudarshan R. Jadcherla
    NeoReviews Feb 2021, 22 (2) e104-e117; DOI: 10.1542/neo.22-2-e104

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    Gastroesophageal Reflux Disease in Neonates: Facts and Figures
    Jenny Bellodas Sanchez, Sudarshan R. Jadcherla
    NeoReviews Feb 2021, 22 (2) e104-e117; DOI: 10.1542/neo.22-2-e104
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    • Table of Contents

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    • 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

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