Presented at the Neonatal Society 2006 Widdowson Meeting.
Ganesan KA, Mani A, Thirunavakkarasu P
North Cheshire Hospitals NHS Trust, WA5 1QE, UK
Background: The management of preterm babies with gastroesophageal reflux disease (GORD) is contentious. The majority of these babies are treated symptomatically without any diagnostic aid. The first line treatment for these babies is the use of feed thickeners (FT). By commencing them on FT, they are exposed to the side effects of FT which can increase their morbidity.
Aim: To determine the efficacy of FT in the symptomatic treatment of GORD in preterm babies of less than 32 weeks gestation.
Materials and methods: A retrospective study of preterm babies of less than 32 weeks gestation with symptoms of GORD was carried out in accordance with UK ethical guidelines. The exclusion criteria consisted of babies with congenital anomalies interfering with normal feeding; sepsis; clinical diagnosis of cows milk protein allergy; complicated GORD – failure to thrive, hematemesis, recurrent respiratory symptoms and treatment with a prokinetic medication prior to and during the duration of the study. Thirty babies who satisfied the above criteria were included in the study. Data was collected regarding the gestation age, sex, birth weight, symptoms of GORD, age of onset of symptoms of GORD, age of onset of treatment with FT and duration of treatment. Gaviscon was used as a feed thickener in these babies. The symptoms of GORD were recorded before and after commencement of feed thickeners based on the following criteria-
Apnoea- cessation of breathing for greater than 20 seconds.
Bradycardia- Decrease in heart rate to < 80 per minute for > 10 seconds.
Desaturation- Consistent decrease in oxygen saturation to less than 92%.
Vomiting- Excludes small possits.
No attempt was made to prove the presence or absence of GORD by invasive techniques like pH studies or impedance studies. The number of episodes of each of the above symptoms was recorded before and after commencement with feed thickeners. Paired t test was used to determine statistical significance as the differences in mean were assumed to be Normally distributed. The data was analysed using SPSS version 12.0.1.
Results: Thirty neonates – 16 male and 14 female infants were included. The results are given as mean (SD). The mean gestational age was 28.56 (5.67). The mean age of onset of symptoms of GORD in these babies was 12.23 (10.36) days. The mean age of onset of treatment was 13.3 (10.93) days. Most of the babies required treatment with FT for just over four weeks. The effect of FT on the symptomatic improvement of GORD is summarised in table 1. None of the differences in mean for each of the symptoms was statistically significant.
Conclusions: There is no evidence that FT is beneficial in the treatment of GORD in preterm babies less than 32 weeks gestation. The onset of symptoms of GORD is about 12 days which can be attributed to the establishment of full enteral feeds. The onset of treatment of GORD is about 13 days. This indicates that clinicians in the hospital where the study was undertaken were trigger happy in prescribing FT without any proven clinical benefit.
Table 1. Comparison of symptoms before and after treatment with FT.
References
1. L Grant, D Cochran. Arch Dis Child Fetal Neonatal Ed 2001; 85: F155-F158.
2. Suys B, De Wolf D, Hauser B, Blecker U et al. J Pediatr Gastroenterol Nutr. 1994 Aug; 19(2):187-90