Gastroesophageal Reflux in Infants <32 Weeks Gestational Age at Birth: Lack of Relationship to Chronic Lung Disease

The objective of this study was to determine the incidence of gastroesophageal reflux (GER) as documented by extended esophageal pH monitoring in symptomatic premature infants and to identify its relationship with chronic lung disease (CLD). This was a retrospective study of 629 infants born <32 weeks gestational age and admitted to the neonatal intensive care unit during the study period. Univariate analyses were done on the 137 infants undergoing the test for the association of the following risk factors with acid reflux: birth weight, gestational age, race, sex, length of stay, bronchopulmonary dysplasia (BPD; O₂ requirement at 28 days), and severe CLD (O₂ requirement at 36 weeks postmenstrual age). Eighty-seven of 137 infants were positive for GER. There was no association of GER with the risk factors studied, nor were there correlations with BPD or severe CLD. GER is common (63%) in premature infants <32 weeks gestational age but clinical symptoms and CLD are poorly correlated with this diagnosis.

KEYWORDS

Bronchopulmonary dysplasia - acid reflux - pH probe

REFERENCES

• 1 Vandenplas Y. Reflux esophagitis in infants and children: a report from the Working Group on Gastro-Oesophageal Reflux Disease of the European Society of Paediatric Gastroenterology and Nutrition.  J Pediatr Gastroenterol Nutr. 1994;  18 413-422
• 2 Jeffery H E, Page M, Post E J, Wood A K. Physiological studies of gastro-oesophageal reflux and airway protective responses in the young animal and human infant.  Clin Exp Pharmacol Physiol. 1995;  22 544-549
• 3 Frakaloss G, Burke G, Sanders M R. Impact of gastroesophageal reflux on growth and hospital stay in premature infants.  J Pediatr Gastroenterol Nutr. 1998;  26 146-150
• 4 Khalaf M N, Porat R, Brodsky N L, Bhandari V. Clinical correlations in infants in the neonatal intensive care unit with varying severity of gastroesophageal reflux.  J Pediatr Gastroenterol Nutr. 2001;  32 45-49
• 5 Giuffre R M, Rubin S, Mitchell I. Antireflux surgery in infants with bronchopulmonary dysplasia.  Am J Dis Child. 1987;  141 648-651
• 6 St Cyr J A, Ferrara T B, Thompson T, Johnson D, Foker J E. Treatment of pulmonary manifestations of gastroesophageal reflux in children two years of age or less.  Am J Surg. 1989;  157 400-403 , discussion 403-404
• 7 Orenstein S R, Orenstein D M. Gastroesophageal reflux and respiratory disease in children.  J Pediatr. 1988;  112 847-858
• 8 Foster L J, Trudeau W L, Goldman A L. Bronchodilator effects on gastric acid secretion.  JAMA. 1979;  241 2613-2615
• 9 Stein M R, Towner T G, Weber R W et al.. The effect of theophylline on the lower esophageal sphincter pressure.  Ann Allergy. 1980;  45 238-241
• 10 Sindel B D, Maisels M J, Ballantine T V. Gastroesophageal reflux to the proximal esophagus in infants with bronchopulmonary dysplasia.  Am J Dis Child. 1989;  143 1103-1106
• 11 Sondheimer J M. Continuous monitoring of distal esophageal pH: a diagnostic test for gastroesophageal reflux in infants.  J Pediatr. 1980;  96 804-807
• 12 Meyers W F, Roberts C C, Johnson D G, Herbst J J. Value of tests for evaluation of gastroesophageal reflux in children.  J Pediatr Surg. 1985;  20 515-520
• 13 Euler A R, Byrne W J. Twenty-four-hour esophageal intraluminal pH probe testing: a comparative analysis.  Gastroenterology. 1981;  80 957-961
• 14 Vandenplas Y, Franckx-Goossens A, Pipeleers-Marichal M, Derde M P, Sacre-Smits L. Area under pH 4: advantages of a new parameter in the interpretation of esophageal pH monitoring data in infants.  J Pediatr Gastroenterol Nutr. 1989;  9 34-39
• 15 Marino A J, Assing E, Carbone M T, Hiatt I M, Hegyi T, Graff M. The incidence of gastroesophageal reflux in preterm infants.  J Perinatol. 1995;  15 369-371
• 16 Hrabovsky E E, Mullett M D. Gastroesophageal reflux and the premature infant.  J Pediatr Surg. 1986;  21 583-587
• 17 Newell S J, Booth I W, Morgan M E, Durbin G M, McNeish A S. Gastro-oesophageal reflux in preterm infants.  Arch Dis Child. 1989;  64 780-786
• 18 Rudolph C D. Probing questions: when is gastroesophageal reflux the cause of symptoms?.  J Pediatr Gastroenterol Nutr. 2000;  30 3-4
• 19 Masclee A A, de Best A C, de Graaf R, Cluysenaer O J, Jansen J B. Ambulatory 24-hour pH-metry in the diagnosis of gastroesophageal reflux disease. Determination of criteria and relation to endoscopy.  Scand J Gastroenterol. 1990;  25 225-230
• 20 Suys B, De Wolf D, Hauser B, Blecker U, Vandenplas Y. Bradycardia and gastroesophageal reflux in term and preterm infants: is there any relation?.  J Pediatr Gastroenterol Nutr. 1994;  19 187-190
• 21 Barrington K J, Tan K, Rich W. Apnea at discharge and gastro-esophageal reflux in the preterm infant.  J Perinatol. 2002;  22 8-11
• 22 Feranchak A P, Orenstein S R, Cohn J F. Behaviors associated with onset of gastroesophageal reflux episodes in infants. Prospective study using split-screen video and pH probe.  Clin Pediatr (Phila). 1994;  33 654-662
• 23 Snel A, Barnett C P, Cresp T L et al.. Behavior and gastroesophageal reflux in the premature neonate.  J Pediatr Gastroenterol Nutr. 2000;  30 18-21
• 24 Omari T, Barnett C, Snel A et al.. Mechanism of gastroesophageal reflux in premature infants with chronic lung disease.  J Pediatr Surg. 1999;  34 1795-1798
• 25 Jolley S G, Halpern C T, Sterling C E, Feldman B H. The relationship of respiratory complications from gastroesophageal reflux to prematurity in infants.  J Pediatr Surg. 1990;  25 755-757
• 26 Working Group of the European Society of Pediatric Gastroenterology and Nutrition . A standardized protocol for the methodology of esophageal pH monitoring and interpretation of the data for the diagnosis of gastroesophageal reflux.  J Pediatr Gastroenterol Nutr. 1992;  14 467-471
• 27 Ng S C, Quak S H. Gastroesophageal reflux in preterm infants: norms for extended distal esophageal pH monitoring.  J Pediatr Gastroenterol Nutr. 1998;  27 411-414