Detection of gastro-oesophageal reflux on the neonatal unit

TY - JOUR

T1 - Detection of gastro-oesophageal reflux on the neonatal unit

AU - Rossor, Tom

AU - Lingam, Ingran

AU - Douiri, Abdellah

AU - Bhat, Ravindra

AU - Greenough, Anne

PY - 2018/3/13

Y1 - 2018/3/13

N2 - Aim To determine whether a pH probe or multichannel intraluminal impedance (MII) more frequently detected gastro-oesophageal reflux and test the hypothesis that acid reflux was associated with lower baseline impedance. Methods A prospective study of infants in whom reflux was suspected and evaluated using combined pH and multichannel impedance. Studies were considered abnormal if the acid index was >10% or there were > 79MII reflux events in 24 hours. The acid index was the percentage of total study time with a pH<four and the acid clearance time (ACT) the time from the pH falling below four to rising above four. Results Forty-two infants (median gestational age 31 (range 23-42) weeks) were assessed. Only nine infants (21%) had abnormal studies, seven detected by pH monitoring, one by MII monitoring and one by both techniques (p=0.04). After correcting for gestational age and postnatal age, baseline impedance remained negatively correlated with the acid index (r=-0.34, p=0.038) and the maximum ACT (r=-0.44, p=0.006) Conclusion Clinical suspicion of reflux was frequently incorrect and reflux was more frequently detected by a pH probe. The inverse relationship of acid reflux to baseline impedance suggests that mucosal disruption may result from acid reflux in this population.

AB - Aim To determine whether a pH probe or multichannel intraluminal impedance (MII) more frequently detected gastro-oesophageal reflux and test the hypothesis that acid reflux was associated with lower baseline impedance. Methods A prospective study of infants in whom reflux was suspected and evaluated using combined pH and multichannel impedance. Studies were considered abnormal if the acid index was >10% or there were > 79MII reflux events in 24 hours. The acid index was the percentage of total study time with a pH<four and the acid clearance time (ACT) the time from the pH falling below four to rising above four. Results Forty-two infants (median gestational age 31 (range 23-42) weeks) were assessed. Only nine infants (21%) had abnormal studies, seven detected by pH monitoring, one by MII monitoring and one by both techniques (p=0.04). After correcting for gestational age and postnatal age, baseline impedance remained negatively correlated with the acid index (r=-0.34, p=0.038) and the maximum ACT (r=-0.44, p=0.006) Conclusion Clinical suspicion of reflux was frequently incorrect and reflux was more frequently detected by a pH probe. The inverse relationship of acid reflux to baseline impedance suggests that mucosal disruption may result from acid reflux in this population.

U2 - 10.1111/apa.14315

DO - 10.1111/apa.14315

M3 - Article

SN - 0803-5253

JO - Acta Paediatrica

JF - Acta Paediatrica

ER -