Gastroesophageal Reflux Disease in the Neonatal Intensive Care Unit Infant: Who Needs to Be Treated and What Approach Is Beneficial?

Ish K Gulati; Sudarshan R Jadcherla

doi:10.1016/j.pcl.2018.12.012

Gastroesophageal Reflux Disease in the Neonatal Intensive Care Unit Infant: Who Needs to Be Treated and What Approach Is Beneficial?

Pediatr Clin North Am. 2019 Apr;66(2):461-473. doi: 10.1016/j.pcl.2018.12.012. Epub 2019 Feb 1.

Authors

Ish K Gulati¹, Sudarshan R Jadcherla²

Affiliations

¹ Innovative Research Program in Neonatal Feeding Disorders; The Neonatal and Infant Feeding Disorders Program, Nationwide Children's Hospital, Columbus, OH, USA.
² Innovative Research Program in Neonatal Feeding Disorders; The Neonatal and Infant Feeding Disorders Program, Nationwide Children's Hospital, Columbus, OH, USA; Division of Neonatology, Department of Pediatrics, Center for Perinatal Research, WB 5211, The Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, 575 Children's Cross Roads, Columbus, OH 43215, USA; Division of Pediatric Gastroenterology and Nutrition, Department of Pediatrics, Center for Perinatal Research, WB 5211, The Research Institute at Nationwide Children's Hospital, The Ohio State University College of Medicine, 575 Children's Cross Roads, Columbus, OH 43215, USA. Electronic address: Sudarshan.Jadcherla@nationwidechildrens.org.

Abstract

Gastroesophageal reflux (GER) and GER disease (GERD) pertaining to infants in the neonatal intensive care unit (NICU) are reviewed, based on research in this specific population. The developmental biology of the gastroesophageal junction, physiology of GER, and pathophysiology of GERD in this setting are summarized, and risk factors for GER and GERD identified. The epidemiology, economic burden, and controversies surrounding GERD in NICU infants are addressed, and an approach to GER and GERD in these patients formulated. Recent advancements in individual assessment of GER and GERD in the NICU infant are examined, and evidence-based guidelines for their adoption provided.

Keywords: GER; GERD; NICU; Neonate; Preterm.

Publication types

Research Support, N.I.H., Extramural
Review

MeSH terms

Esophageal Sphincter, Lower / physiopathology*
Gastroesophageal Reflux / diagnosis*
Gastroesophageal Reflux / etiology
Gastroesophageal Reflux / therapy
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Manometry / methods
Risk Factors

Grants and funding

R01 DK068158/DK/NIDDK NIH HHS/United States