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Investigation and management of gastro‐oesophageal reflux in United Kingdom neonatal intensive care units
Author(s) -
Rossor Thomas,
Andradi Gwendolyn,
Bhat Ravindra,
Greenough Anne
Publication year - 2018
Publication title -
acta paediatrica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.772
H-Index - 115
eISSN - 1651-2227
pISSN - 0803-5253
DOI - 10.1111/apa.14073
Subject(s) - medicine , domperidone , gastro , reflux , ranitidine , intensive care , neonatal intensive care unit , gerd , pediatrics , neonatology , intensive care medicine , disease , pregnancy , biology , genetics , dopamine
Aim In 2004, wide variation in the investigation and management of gastro‐oesophageal reflux ( GOR ) of infants on UK major neonatal units was demonstrated. Our aim was to resurvey neonatal practitioners to determine current practice and whether it was now evidence based. Methods A questionnaire was sent to all 207 UK neonatal units. Results Responses were obtained from 84% of units. The most frequent ‘investigation’ was a trial of therapy (83% of units); pH studies were used in 38%, upper GI contrast studies in 19% and multichannel intraluminal impedance ( MII )/ pH studies in 5%. Only six units suggested a threshold for an abnormal pH study and two units for an abnormal MII study. Infants were commenced on antireflux medication without investigation always in 32% of units, often in 29%, occasionally in 19% and only never in 1%. Gaviscon was used as first line treatment in 60% of units, and other medications included ranitidine in 53%, thickening agents in 27%, proton pump inhibitors in 23%, domperidone in 22% and erythromycin in 6%. Conclusion There remains a wide variation in diagnostic and treatment strategies for infants with suspected GOR on neonatal intensive care units, emphasising the need for randomised trials to determine appropriate GOR management.