The Turkish Journal of Pediatrics
2012 , Vol 54 , Num 6
Gastroesophageal Reflux (GER) in Preterms: Current Dilemmas and Unresolved Problems in Diagnosis and Treatment
Division of Neonatology, Department of Pediatrics, Ege University Faculty of Medicine, Izmir, Turkey.
E-mail: nilgun.kultursay@ege.edu.tr
Gastroesophageal reflux (GER) is a common physiologic phenomenon in
preterm infants. Many infants remain asymptomatic, and the diagnosis of
GER is difficult since clinical signs and symptoms are nonspecific. Diagnosis
can also be difficult due to technical limitations. None of the currently
available agents has been proven to prevent regurgitation. The efficacy and
safety of gastroesophageal reflux disease (GERD) therapy have not been
studied systematically in preterm infants. Therefore, clinicians must consider
the risks and benefits of therapy. Preventive measures should be the firstline
intervention. Prone, head upward and left-side positioning may reduce
symptoms, but infants must be discharged home in the supine position.
Thickening of feeds may be harmful in preterm infants. Frequent small-amount
or continuous-drip feeding, short-term trial of hypoallergenic formula and
probiotics are among the proposed treatments. Infants with severe symptoms
and those who do not respond to the conservative and medical treatment
need further diagnostic evaluation and very rarely a Nissen fundoplication.
Keywords :
gastroesophageal reflux, preterms, diagnosis, treatment.