Abstract
Gastroesophageal reflux (GOR) is very common among preterm infants, due to several physiological mechanisms. Although GOR should not be usually considered a pathological condition, its therapeutic management still represents a controversial issue among neonatologists; pharmacological overtreatment, often unuseful and potentially harmful, is increasingly widespread. Hence, a stepwise approach, firstly promoting conservative strategies such as body positioning, milk thickening, or changes of feeding modalities, should be considered the most advisable choice in preterm infants with GOR. This review focuses on the conservative management of GOR in the preterm population, aiming to provide a complete overview, based on currently available evidence, on potential benefits and adverse effects of nonpharmacological measures. Nonpharmacological management of GOR might represent a useful tool for neonatologists to reduce the use of antireflux medications, which should be limited to selected cases of symptomatic babies.
Highlights
Gastroesophageal reflux (GOR) is common in preterm infants, with a 22% estimated incidence in babies born before 34 weeks of gestation [1]
A stepwise approach, promoting at first nonpharmacological interventions such as body positioning, milk thickening, or modifications in feeding modalities, should be considered the most advisable choice to manage GOR in preterm infants [3, 5, 9]; this would allow avoiding pharmacological treatment, which could be limited to those infants who do not benefit from conservative measures or who experience GOR clinical complications [10]
A significant decrease in total acid GOR episodes and reflux index was observed in newborns fed the Extensively HPFs (eHPFs), whereas no difference between the two formulas was found in terms of GOR height and nonacid GOR features [58]
Summary
Gastroesophageal reflux (GOR) is common in preterm infants, with a 22% estimated incidence in babies born before 34 weeks of gestation [1]. It should be considered that many pharmacological therapies act on acid GOR, while different conservative strategies have different effects on acid and nonacid GORs. Due to its ability to both detect acid, weakly acid, and alkaline GORs [17] and assess the physical nature (gaseous, liquid, or mixed) of reflux episodes, combined multiple intraluminal impedance (MII) and pH monitoring is highly effective in detailing GOR features, being superior to pHmetry and MII alone. Due to its ability to both detect acid, weakly acid, and alkaline GORs [17] and assess the physical nature (gaseous, liquid, or mixed) of reflux episodes, combined multiple intraluminal impedance (MII) and pH monitoring is highly effective in detailing GOR features, being superior to pHmetry and MII alone It is currently considered the best choice to diagnose GOR [3, 19] and to evaluate the efficacy of antireflux therapy [20]. This review focuses on conservative management of GOR in preterm infants, aiming to provide a complete overview on potential benefits and adverse effects of currently available nonpharmacological measures
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