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Behavior and Gastroesophageal Reflux in the Premature Neonate

Snel, Antonie; Barnett, Christopher P.; Cresp, Trevor L.; Haslam, Ross R.; Davidson, Geoffery P.*; Malbert, Charles H.; Dent, John; Omari, Taher I.*

Journal of Pediatric Gastroenterology and Nutrition: January 2000 - Volume 30 - Issue 1 - p 18-21
Original Articles

Background: The belief that behavioral observations assist in the clinical diagnosis of gastroesophageal reflux (GER) disease in premature neonates has not been formally tested. The purpose of this study was to determine whether esophageal acidification was associated with a recognizable pattern of behavioral changes in these infants.

Methods: The behavior of 14 healthy premature infants was recorded by a video camera while esophageal pH was simultaneously monitored. For each of 20 acid GER episodes recorded, a 10-minute video epoch, encompassing the onset of acid GER and lasting at least 4 minutes after the onset of GER, was examined. Two independent observers each scored reflux-associated epochs of “general” infant behavior and behavior previously shown to be indicative of reflux in normal term infants.

Results: The occurrence of esophageal acidification due to reflux did not significantly alter scores for general behavior. Infants frequently demonstrated reflux-specific behavior, including discomfort, head retraction, and mouthing; however, none of these behavioral patterns was temporally associated with the occurrence of acid GER.

Conclusions: These data indicate that reflux-specific behavioral criteria, established in older term infants, may be inappropriate as diagnostic criteria for GER in premature neonates and may lead to the unnecessary use of antireflux therapy.

Neonatal Medicine and *Gastroenterology Unit, Women's and Children's Hospital, North Adelaide, Australia; †Unite Des Flux Digestif, Institute National de la Recherche Agronomique, St. Gilles, France; and ‡Gastrointestinal Medicine, Royal Adelaide Hospital, Adelaide, Australia

Received March 25, 1999;

revised June 14, 1999; accepted July 19, 1999.

Supported by the National Health and Medical Research Council of Australia, the J. H. and J. D. Gunn Medical Research Foundation, and Channel 7 Children's Research Foundation of South Australia.

Address correspondence and reprint requests to Dr. Taher Omari, Gastroenterology Unit, Women's and Children's Hospital, North Adelaide, SA 5006, Australia.

This article is accompanied by an editorial. Please see: Rudolph CD. Probing questions: When is gastroesophageal reflux the cause of symptoms? J Pediatr Gastroenterol Nutr 2000;30;3–4.

© 2000 Lippincott Williams & Wilkins, Inc.