High Prevalence of Esophageal Acid Exposure in Very Low Birth Weight Infants Presenting or Not Bronchopulmonary Dysplasia: A Prospective Cross-Sectional Study

Abstract

Background: A high frequency of treatment for gastroesophageal reflux disease is observed in neonates with Bronchopulmonary Dysplasia (BPD). The association between these illnesses is controversial. Objective: To determine the prevalence of reflux index ≥ 10%, in very low birth weight infants, presenting or not BPD, using esophageal pH monitoring. Methods: A prospective cross-sectional study was conducted. Thirty-five newborns presenting BPD and 15 newborns not presenting BPD underwent distal esophageal pH monitoring during their stay in a university hospital neonatal unit. The frequency of symptoms and gastroesophageal reflux treatment was studied in both groups. Results: The prevalence of reflux index ≥ 10% did not differ between groups presenting (65.7%) and not presenting BPD (93.3%); p=0.075. Symptoms attributable to gastroesophageal reflux occurred in 91.4% of newborns presenting BPD and in 73.3% of the group not presenting BPD. Antireflux treatment was introduced to 80% of the subjects presenting BPD and to 20% of patients who were not presenting BPD; (p<0.001). Conclusions:There is a high prevalence of increased esophageal mucosal exposure to acid in very low birth weight infants presenting or not BDP. The symptoms attributable to gastroesophageal reflux are frequent in both groups; however, in very low birth weight infants, not presenting BPD, a clinical progression complicated by gastroesophageal reflux is less frequent. Nevertheless, BPD is associated with a higher frequency of gastroesophageal reflux treatment, the indication of any therapeutic modality must be cautious, and the laboratory investigation associated with a clinical evaluation may contribute to a reduction in the number of unnecessary treatment.