Gastro-oesophageal reflux in preterm infants

• Published in: Archives of disease in childhood Vol. 64; no. 6; pp. 780 - 786
• Main Authors: Newell, S J, Booth, I W, Morgan, M E, Durbin, G M, McNeish, A S
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 01-06-1989; BMJ; BMJ Publishing Group LTD
• Subjects: Antimony; Apnea - complications; Apnea - drug therapy; Biological and medical sciences; Critical Care; Esophagus; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal Reflux - etiology; Humans; Hydrogen-Ion Concentration; Infant Nutritional Physiological Phenomena; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases - etiology; Infants; Medical sciences; Nursing Care; Other diseases. Semiology; Premature Infants; Time Factors; Xanthines - therapeutic use; Young Children; Human; Premature; Gastroesophageal reflux; Infant
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/adc.64.6.780

Gastro-oesophageal reflux in very low birthweight infants was studied using a new 1 mm monocrystalline antimony oesophageal pH electrode. Gastro-oesophageal reflux was detected in 30 (85%) subjects. The mean (SEM) number of episodes of reflux in 24 hours was 12.1 (2.1), and 3.2 (0.6) lasted over five minutes. The mean reflux index was 4.5 (1.0)%, and the longest episode 17.1 (4.6) 17.1. Reflux was unrelated to postconceptional age or to resting lower oesophageal sphincter pressure. The mean reflux index was low at rest before feeds, being 1.8 (0.6)%, and increased slightly after feeds (3.8 (1.0)%), but was significantly increased after nursing care to 16.4 (3.0)%, and while xanthines were being given (5.9 (1.6)%. A subgroup of seven infants with xanthine resistant apnoea had severe gastro-oesophageal reflux that was not clinically apparent (reflux index 27.4 (3.6)%). Successful treatment of the reflux (reflux index: 3.6 (1.2)%) was associated with cessation of the apnoea. We conclude that gastro-oesophageal reflux is common, and is usually not clinically apparent, even when severe. It is important to consider gastro-oesophageal reflux in the differential diagnosis of xanthine resistant apnoea in preterm infants.