GERD in NICU Infants: Is a 24-hour pH Probe Study Always Necessary Prior to Gastrostomy Placement? J Baerg MD, C Tai MD, E Tagge MD, D Deming MD Loma Linda University Children’s Hospital So Cal Chapter of American College of Surgeons-Ped Surg Section Jan 2010 ( 9/2009 - 1/2010 )
Introduction: NICU infants who require a gastrostomy, are frequently evaluated for GERD by 24-hour pH probe, despite the absence of symptoms. Objectives: 1) To identify the incidence of GERD in NICU infants requiring gastrostomy. 2) To identify factors associated with GERD. 3) To evaluate growth curves and identify development of GERD during follow-up. Methods: An IRB approved retrospective review was carried out between January 2004 and December 2006. 100 NICU infants under age 6 months, underwent a 24-hour pH probe prior to gastrostomy placement. Growth curves were reviewed at time of probe, 6 months later and at study completion (2-5 years follow-up). Data were analyzed by Chi-square and logistic regression. P values </= 0.05 were considered significant. Results: Thirty-four infants (34%) had GERD. Factors associated with GERD on univariate analysis were: neurologic impairment (p=0.001), prematurity (p=0.001), aspiration symptoms (p=0.002), intraventricular hemorrhage (p=0.002), seizures (p=0.005), and vomiting (p=0.005). Independent predictors were: neurologic impairment, OR 7.1 (95%CI 1.9-26), prematurity, OR 4.6 (95%CI 1.7-12.8), aspiration, OR 3.6 (95%CI 1.1-12.0), and vomiting, OR 3.4 (95%CI 1.4-8.0). Ninety-two infants(92%) had complete follow-up. Thirty (33%) had GERD and 62 (77%) did not. Despite initiation of therapy for GERD, 3/30 had recurrent symptoms of GERD but were growing well. All 62 who were GERD negative underwent only gastrostomy. Fifty-two of 62 continued to be symptom free and maintained their growth curves. Ten of 62 began vomiting 3-24 months after the initial probe (median: 7 months) and were restudied. All had GERD and 8 were losing weight. Conclusion: The incidence of GERD in NICU infants undergoing gastrostomy was 34%. Evaluation in this group should be directed to infants with neurologic impairment, prematurity, aspiration or vomiting. Infants without these factors may be over studied. Those without GERD at the time of initial gastrostomy, who subsequently develop GERD symptoms, should be re-evaluated promptly before they show evidence of failure to thrive.