Risk factors for severe esophageal and gastric lesions in term neonates: a case-control study. Groupe Francophone d'Hépato-Gastroentérologie et Nutrition Pédiatrique.

Abstract

The purpose of this multicenter case-control study was to search for causes and risk factors related to the severe upper digestive tract lesions often seen in neonates. Case patients were full-term neonates with endoscopically confirmed severe bleeding or ulcerative lesions of the esophagus and/or stomach. Matched control subjects were the next infant born in the same maternity unit who met the same criteria and had no clinical abnormality (and, for ethical reasons, no endoscopy). The analysis was based on 137 case-control pairs and considered data showing the mothers' medical and obstetric background, the infants' clinical status and laboratory results, feeding details, and the State and Trait Anxiety Inventory (STAI) questionnaire, which was used to assess the anxiety of the mothers. Cases and controls did not differ in any demographic or social factors. Antacid and anti-ulcer drugs were used significantly more frequently during the last month of pregnancy by case mothers than by control mothers (28% and 10%, respectively; P < 0.001). Mode of delivery was similar. Case infants more frequently experienced cardiac deceleration during labor and delivery (28% and 12.9%; P = 0.003). Breastfeeding at birth was less frequent for case infants (36% and 49%; P = 0.05). The mean trait anxiety scores did not differ between the two groups, but the mean state anxiety score was higher in case mothers. Multivariate logistic regression found that three factors were independently and significantly associated with esophageal and gastric lesions: use of antacid and antiulcer treatments (odds ratio [OR], 3.9; P < 0.001), cardiac deceleration (OR, 2.2; P = 0.03), and breast-feeding (OR, 0.5; P = 0.02). Antacid drug use by mothers during the last month of pregnancy was associated with esophageal and gastric lesions. Breast-feeding may play a protective role against severe lesions in neonates.