This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow P3Rs: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when P3Rs are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via ISI Web of Science (5)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Poets, C. F.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Poets, C. F.
Related Collections
Right arrow Premature & Newborn
PEDIATRICS Vol. 113 No. 2 February 2004, pp. e128-e132

ELECTRONIC ARTICLE

Gastroesophageal Reflux: A Critical Review of Its Role in Preterm Infants

Christian F. Poets, MD

From the Department of Neonatology, University of Tuebingen, Tuebingen, Germany

There is widespread concern about gastroesophageal reflux (GER) in preterm infants. This article reviews the evidence for this concern. GER is common in infants, which is related to their large fluid intake (corresponding to 14 L/day in an adult) and supine body position, resulting in the gastroesophageal junction’s being constantly "under water." pH monitoring, the standard for reflux detection, is of limited use in preterm infants whose gastric pH is >4 for 90% of the time. New methods such as the multiple intraluminal impedance technique and micromanometric catheters may be promising alternatives but require careful evaluation before applying them to clinical practice. A critical review of the evidence for potential sequelae of GER in preterm infants shows that 1) apnea is unrelated to GER in most infants, 2) failure to thrive practically does not occur with GER, and 3) a relationship between GER and chronic airway problems has not yet been confirmed in preterm infants. Thus, there is currently insufficient evidence to justify the apparently widespread practice of treating GER in infants with symptoms such as recurrent apnea or regurgitation or of prolonging their hospital stay, unless there is unequivocal evidence of complications, eg, recurrent aspiration or cyanosis during vomiting. Objective criteria that help to identify those presumably few infants who do require treatment for GER disease are urgently needed.

Key Words: lower esophageal sphincter • regurgitation • treatment indications

Abbreviations: GER, gastroesophageal reflux • CMA, cow milk protein allergy • TLESR, transient lower esophageal sphincter relaxation • GERD, gastroesophageal reflux disease • MII, multiple intraluminal impedance • AOP, apnea of prematurity • NICU, neonatal intensive care unit

Received for publication Aug 8, 2003; Accepted Oct 6, 2003.




This article has been cited by other articles:


Home page
 AAP Grand RoundsHome page
D. Kawatu and N. LeLeiko
Birth Weight, Gastroesophageal Reflux, and Adult Onset Esophageal Adenocarcinoma: A Relationship?
AAP Grand Rounds, June 1, 2005; 13(6): 69 - 70.
[Full Text] [PDF]

Home page
 NeoReviewsHome page
S. R. Jadcherla and C. D. Rudolph
Gastroesophageal Reflux in the Preterm Neonate
NeoReviews, February 1, 2005; 6(2): e87 - e98.
[Full Text] [PDF]