Gastro-oesophageal reflux in preterm infants

Abstract

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.