الفهرس 
GASTRO ESOPHAGEAL REFLUX IN PRETERMOnly 14 pages are availabe for public view
 |  | from | 165 |  |  |
| | | from | 165 | | |
Abstract
G
astro esophageal reflux (GER) is common during infancy, especially in preterm infants. The increased risk of GERD in preterm infants is thought to be due to immature or impaired anatomic and physiologic factors. Most infants have no complications from their GER and do not require further evaluation or intervention because GER usually resolves without intervention by one year of age.
GER disease (GERD) is defined as GER that causes morbidity. Signs or symptoms that are often attributed to GER include irritability, nonspecific behaviors suggesting discomfort such as posturing or grimacing, frequent bouts of emesis, worsening of lung disease, and failure to thrive. However, it is likely that in many cases GERD is not the underlying cause of these symptoms. In addition, GERD is probably not a common trigger or mechanism for pathologic apnea of prematurity, although in selected cases a causal relationship may exist.
The diagnosis of GERD is challenging in preterm infants because symptoms are nonspecific, and diagnostic testing (esophageal pH and multiple intraluminal impedance monitoring) is limited due to technical problems and difficulties of interpreting results in the newborn. Moreover, esophageal monitoring rarely establishes a causal association between GER and pathologic consequences.
As a result, the diagnosis of GERD usually depends on the clinician’s clinical suspicion that a pathological problem in an individual (eg, poor growth, apnea of prematurity or chronic lung disease) is likely to be caused by GERD, based on a global assessment and exclusion of other causes of the symptoms. In some cases, an empiric time-limited trial of acid suppression is used in an attempt to clarify the diagnosis.
This study was designed to evaluate the detection of pepsin (A) in mouth swab in neonates with clinical gastro esophageal reflux; our aim was to evaluate the salivary pepsin as a diagnostic marker of GERD. Secondary aim was to study relation between level of salivary pepsin (A) and duration of mechanical ventilation, duration of hospitalization and mortality.
Salivary pepsin A concentration was evaluated by detection of salivary pepsin A in mouth swabs by (enzyme linked immunosorbent assay) ELISA technique using pepsin (A) kits.
This study included 91 neonates who were admitted to the NICUs of Ain Shams University Hospitals,46 for the case (with clinical Gastro esophageal reflux) and 45 samples for control (without clinical gastro esophageal reflux) from January 2018 through august 2018 over 7 months.
The studied neonates include 55 males and 36 females with gestational age ranged between 28 and 36 weeks, 8 delivered vaginally and 83 delivered by caesarean section, the studied neonates were divided into two distinct groups, group A with established diagnosis of gastroesophageal reflux, (this group was subdivided into two groups one with risk factor and the other without risk factors) and non GERD neonates as group B.
Established clinical GERD group was diagnosed based on clinical observation.
As regards the demographic and clinical data of the included preterm neonates, there were also no statistically significant differences between both study groups in terms of gestational age, mode of delivery, birth weight, and age of admission, Apgar score, and gender.
Preterm neonates with GERD showed higher statistically significant older in age, high respiratory rate, high concentration of pepsin A level in saliva, more length of hospital stay than those of non GERD group.
Preterm neonates with GERD with risk factors (respiratory distress, sepsis, and neurological impairment and GIT surgery) showed a higher incidence of GERD than non GERD group while, both groups showed there was no statistical significance in Presence of nasogastric tube as a risk factor for GERD.
Salivary pepsin A level is significantly higher in reflux group when compared to the non- reflux group. Salivary pepsin A level can diagnose the clinical GERD with a cutoff value > 132.8 ng/ml with a sensitivity of 79% and a specificity of 80%.
Regarding GERD group, age of preterm > 3 days, Breast feed, NEC bells staging Sandifer positioning, respiratory rate (RR) > 51 and Antibiotics use act as predictors which make preterm neonates susceptible to GERD and increase incidence of it.