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Abstract
Introduction Proton pump inhibitors are being used excessively for treatment of neonates with gastroesophageal reflux disease, however, whether or not these infants do benefit from this treatment is still questionable.
The aim of the study: is to evaluate the effect of 0.7mg/kg/day of intravenous omeprazole on neonatal GERD by using multichannel oesophageal impedance and PH monitoring before and after treatment with PPI.
Methods A randomised cross over study was performed on 20 neonates (31–37 weeks’ gestational age) with symptoms and signs of GERD.
Infants had multichannel oesophageal impedance and PH monitoring done before and after omeprazole therapy (on day 0 and day 7 post treatment).
Results Omeprazole significantly reduced the lowest PH recorded in lower oesophagus (pre treatment 0.85 vs post 2.4, p < 0.001) and significantly reduced mean acid clearance time (%) (pre 15.1% vs post 2.1%,p < 0.001) however, the total number of impedance lowering events wasn’t affected (pre 35 vs post 32, p = 0.154).
Regarding the symptom sensitivity index pre and post treatment with PPI*
The number of Acidic reflux episodes decreased significantly (pre 9 vs post 0,p < 0.001), whereas total number of weakly acidic episodes median was 25 before PPI therapy with IQR(16–28), and after therapy was 30 with IQR(21–34).
Regarding the symptomatology of gastroesophageal reflux disease in the studied neonates, all 20 neonates had poor weight gain, recurrent aspiration and anaemia while 11 neonate (55% of total patients) had sandifer’s syndrome,15(75%) experienced spells and the frequency of spell per patient was on average (1–3 episode/day), 18 neoante (90%)had irritability, and all did suffer from regurgitation and the average frequency of regurgitation per day was from 5–8 episodes per neonate.
Conclusions PPI therapy does not affect the symptoms, signs or number of weakly acidic or alkaline reflux episodes which represent the commonest type of neonatal GERD. However, it affects only the acid clearance time and the number of acidic reflux episodes. These findings may indicate the over-use of PPI and the need to change the prescription pattern for neonatal GERD.