Can pH monitoring reliably detect gastro-oesophageal reflux in preterm infants?

Grant, Louise; Cochran, Dominic

doi:10.1136/fn.85.3.f155

Cited by 54 publications

(51 citation statements)

References 29 publications

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“…Reflünün varlığını göstermede en etkin yöntemlerden biri olarak kabul edilmektedir. Ancak, tedavi aşamasında medikal ya da cerrahi gereklilik konusunda yol gösterici değil-dir (2,11) . Çalışmamızda, Grup 1 ve Grup 2 arasında 24 saat pH monitörizasyonun reflüyü saptaması açı-sından istatiksel olarak anlamlı bir fark saptanmamıştır (p>0,05).…”

Section: Discussionunclassified

“…Yirmi dört saatlik pH monitörizasyonu ise en güve-nilir yöntemlerden biri olarak tanı protokolündeki yerini korumaktadır (1,2,11,15,18,19) . Yirminci yüzyılın ikinci yarısından itibaren uygulanmaya başlanan özofagus motilite çalışmaları kısa sürede yapılabilmesi ve doku düzeyinde hasar oluşmadan hastalığı saptayabilmesi nedeni ile (5,6,9,10,12,13) önce erişkin hasta popülasyonun-da daha sonra çocuk hasta popülasyonunda uygulanmaya başlanmıştır.…”

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To compare efficiency of diagnositc modalities in gastroesophageal reflux disease

Aydın¹,

Özcan²,

Adaletli³

et al. 2015

Tccd

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Section: Discussionunclassified

unclassified

To compare efficiency of diagnositc modalities in gastroesophageal reflux disease

Aydın¹,

Özcan²,

Adaletli³

et al. 2015

Tccd

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“…The sensitivity and specificity of esophageal pH monitoring for the detection and quantification of GER are 87%-93% and 93%-97%, respectively (25). In prematurely born infants, it has been suggested that this method of monitoring may not be that reliable, as GER cannot be detected when the gastric pH is Ͼ4, and in prematurely born infants, the gastric pH may be Ͼ4 for the majority of the time (26,27). In this study, pH monitoring was used in both positions and, as there is no evidence to suggest esophageal pH monitoring function is influenced by sleeping position, our findings of differences in acid reflux between positions are robust.…”

Section: Discussionmentioning

confidence: 99%

Acid Gastroesophageal Reflux in Convalescent Preterm Infants: Effect of Posture and Relationship to Apnea

et al. 2007

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Concerns regarding gastroesophageal reflux (GER) and associated apnea episodes result in some practitioners having convalescent, prematurely born infants sleep in the prone position. We have tested the hypothesis that such infants would not suffer from clinically important acid GER or associated apnea episodes more in the supine compared with the prone position. Lower esophageal pH was measured and videopolysomnographic recordings of nasal airflow, chest and abdominal wall movements, electrocardiographic activity, and oxygen saturation were made on two successive days of 21 premature infants (median gestational age 28 wk) at a median postmenstrual age (PMA) of 36 wk. On each day, the infants were studied prone and supine. The acid reflux index was higher in the supine compared with the prone position (median 3% versus 0%, p ϭ 0.002), but was low in both positions. The number of obstructive apnea episodes per hour was higher in the supine position (p ϭ 0.008). There were, however, no statistically significant correlations between the amount of acid GER and the number of either obstructive or total apnea episodes in either the supine or prone position. Supine compared with prone sleeping neither increases clinically important acid GER nor obstructive apnea episodes associated with acid GER in asymptomatic, convalescent, prematurely born infants. (Pediatr Res 62: 620-623, 2007) P rematurely born infants are at increased risk of sudden infant death syndrome (SIDS), particularly if they sleep in the prone position (1). Despite this known adverse association, some prematurely born infants still sleep in the prone position at the age when they are at highest risk of SIDS (2). Several studies have highlighted that parents are strongly influenced by health care practitioners with regard to their choice of sleeping position for their infant (3,4). Worryingly, the results of a national survey (5) revealed that in some neonatal units, prematurely born infants slept in the prone position even just before discharge from the neonatal intensive care unit (NICU). One of the reasons given for continuation of prone sleeping is the perceived increased risk of gastroesophageal reflux (GER) in the supine position (6) and that the likelihood of associated problems such as apnea may be less in the prone position. Yet, it is known that there is maturation of the reflexes that protect against GER and esophagopharyngeal reflux (7). Esophageal and upper esophageal sphincter motor responses to abrupt mid-esophageal provocation are present as early as 33 wk PMA, and the response characteristics improve during development (7). We, therefore, hypothesized that convalescent, asymptomatic, prematurely born infants ready for NICU discharge would not suffer from either clinically important acid GER or apnea episodes associated with acid GER more in the supine compared with the prone position. The aim of this study was to test that hypothesis by investigating the influence of sleeping position on acid reflux and any association with apnea...

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“…Dhillon and Ewer [13] showed that intra-oesophageal pH monitoring was available in 93% of Neonatal Intensive Care Units (NICU) and Neonatal Special Care Units (NSCU) of England and Wales, but used regularly in only 32% of suspected cases. This is because there is a lack of published values for reflux variables in preterm infants that makes interpretation of pH monitoring difficult [14] . However, continuous pH monitoring is still a primary method to evaluate GOR in NICU and NSCU [13] .…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of Gastro-Oesophageal Reflux in Preterm Infants: Sonography vs. pH-Monitoring

et al. 2006

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Objectives: To compare the ultrasound examination with pH-metry in order to evaluate the diagnostic accuracy of sonography for diagnosis of gastro-oesophageal reflux (GOR) in preterm infants. Methods: A prospective study was conducted on 31 premature infants <34 weeks with clinically diagnosed GOR. First, they underwent 24-hour pH-monitoring; successively, the sonographic assessment was performed within 12 h after pH-monitoring. The two operators who performed the pH-monitoring and sonography respectively, were unaware of each other’s results. Results: Twenty-one patients (67.7%) had significant GOR with a reflux index >5 (GOR group). The median (range) reflux index in this group was 9.19% (6.04–20.1). Ten newborns (32.3%) did not have significant GOR with a reflux index <5. Sonography was positive for GOR in 8 patients (25.8%); all 8 infants with sonographic diagnosis of GOR had a reflux index >5. Therefore, sonographic diagnosis did not produce false positives. Sonography was negative in 23 newborns (74.2%); 13 of these were positive to pH-monitoring and may therefore be considered as false negatives. Respect to continuous 24-hour pH-monitoring, sonography showed a specificity of 100% but a very low sensitivity of 38% with a positive prediction value of 100% and a negative prediction value of 43%. Conclusions: Sonography should not replace 24-hour pH monitoring for detecting GOR in preterm infants. However, sonography has a very high specificity and a positive predictive value of 100%. When clinicians suspect GOR in preterm infants, it could be useful for selection of cases to refer for pH-metry.

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Can pH monitoring reliably detect gastro-oesophageal reflux in preterm infants?

Cited by 54 publications

References 29 publications

To compare efficiency of diagnositc modalities in gastroesophageal reflux disease

To compare efficiency of diagnositc modalities in gastroesophageal reflux disease

Acid Gastroesophageal Reflux in Convalescent Preterm Infants: Effect of Posture and Relationship to Apnea

Diagnosis of Gastro-Oesophageal Reflux in Preterm Infants: Sonography vs. pH-Monitoring

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