Prevalence and Risk Factors for Gastroesophageal Reflux in Symptomatic Very Preterm Neonates

Background: Because of immature development, preterm infants are prone to respiratory and digestive symptoms of dyspnea, vomiting, and aspiration pneumonia. These symptoms are often observed in infants with gastroesophageal reflux (GER). However, the relationship between GER and these symptoms remain unclear. Methods: A cohort of 61 preterm infants born at 32 weeks of gestation or earlier with respiratory or digestive symptoms were retrospectively reviewed. All the preterm infants underwent 24-hour pH-multichannel intraluminal impedance monitoring. Clinical data were analyzed using logistic regression analyses. Results: Among the 61 symptomatic preterm infants, 34 were positive for pathologic GER with a prevalence of 55.7%. The GER associated symptoms included apnea (42.6%), cyanosis (19.7%), vomiting (14.8%), pneumonia (9.8%), and poor weight gain (13.1%). These respiratory and digestive symptoms were more frequent in infants with pathologic GER than in those without. (p<0.05) The risk factors for GER included severe BPD (odds ratio [OR], 6.890; 95% confidence interval [CI], 1.125-42.209). Probiotics and delayed full oral feeds reduced the risk of GER (odds ratio [OR], 0.642; 95% confidence interval [CI], 0.457-0.901, p<0.05; OR, 0.234, 95% CI, 0.069-0.794, p<0.05). Conclusions: The prevalence of GER is high in the symptomatic preterm infants. GER aggravates the respiratory and digestive symptoms holding that not all the symptoms are GER associated. Probiotics and delayed full oral feeds can decrease the prevalence of GER.