Practice Variance, Prevalence, and Economic Burden of Premature Infants Diagnosed With GERD

Jadcherla, Sudarshan R.; Slaughter, Jonathan L.; Stenger, Michael R.; Klebanoff, Mark A.; Kelleher, Kelly J.; Gardner, William

doi:10.1542/hpeds.2013-0036

Cited by 62 publications

(53 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…21 Not knowing the mechanism for ALTEs, multiple etiologies are investigated and empiric therapies are frequent. 2,3,7,25 A common assumption of ALTE is the association with GER; however, the attributable aero-digestive mechanisms remain unclear. Hence, we evaluated the reciprocal relationships between swallow-integrated esophageal motility and respiratory waveform patterns.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Respiratory Events in Infants Presenting with Apparent Life Threatening Events: Is There an Explanation from Esophageal Motility?

Hasenstab

Jadcherla

2014

The Journal of Pediatrics

Self Cite

View full text Add to dashboard Cite

Objectives To test the hypothesis that proximal aero-digestive clearance mechanisms mediated by pharyngo-esophageal motility during spontaneous respiratory events (SREs) are distinct in infants with apparent life threatening events (ALTE). Study design Twenty infants (10 with proven ALTE, 10 healthy controls) had pharyngo-esophageal manometry to investigate motility changes concurrent with respiratory events detected by respiratory inductance plethysmography and nasal thermistor methods. We measured changes in resting upper esophageal and lower esophageal sphincter pressures, esophageal peristalsis characteristics, and gastro-esophageal reflux (GER). Statistical analysis included mixed models; data presented as mean ± SD, median (range), or percentage. Results Infants with ALTE (vs. controls) had: (1) delays in restoring aero-digestive normalcy as indicated by more frequent (P=0.03) and prolonged SREs (P<0.01); (2) a lower magnitude of protective upper esophageal sphincter contractile reflexes (P=0.01); (3) swallowing as the most frequent esophageal event associated with SREs (84%), with primary peristalsis as the most prominent aero-digestive clearance mechanism (64% vs 38%, P<0.01); (4) a higher proportion of failed esophageal propagation (10% vs. 0%, P=0.02); and (5) more frequent mixed apneic mechanisms (P<0.01) and more gasping breaths (P=0.04). Conclusions In infants with ALTE, prolonged SREs are associated with ineffective esophageal motility characterized by frequent primary peristalsis and significant propagation failure, thus suggestive of dysfunctional regulation of swallow-respiratory junction interactions. Hence, treatment should not target GER, but rather the proximal aero-digestive tract.

show abstract

Section: Discussionmentioning

confidence: 99%

“…They also commonly receive empirical treatment for acid-GER. 2,3,7 Frequent and prolonged ALTE occurrences may result in multiple hospital readmissions, emergency visits, numerous parental work absences and increased economic burden. In a study of 12,067 patients with ALTE, the average length of hospital stay was 4.4 days with an average cost of $15,567.…”

mentioning

confidence: 99%

Respiratory Events in Infants Presenting with Apparent Life Threatening Events: Is There an Explanation from Esophageal Motility?

Hasenstab

Jadcherla

2014

The Journal of Pediatrics

Self Cite

View full text Add to dashboard Cite

show abstract

“…The estimated prevalence of GER disease is about 10% in sick infants in Neonatal Intensive Care Unit (NICU). 12 …”

Section: Introductionmentioning

confidence: 99%

“…Therefore, accurate diagnosis of the cause of the symptoms is critical since inappropriate, incorrect treatment is time consuming, wasteful and ineffective. 12, 14, 15 …”

Section: Introductionmentioning

confidence: 99%

The Role of Sleep in the Modulation of Gastroesophageal Reflux and Symptoms in NICU Neonates

Qureshi

Malkar

Splaingard

et al. 2015

Pediatric Neurology

View full text Add to dashboard Cite

Background Newborns sleep about 80% of the time. Gastroesophageal reflux (GER) disease is prevalent in about 10% of NICU infants. Concurrent polysomnography and pH-impedance studies clarify relationship of GER with sleep. Aims To characterize spatio-temporal and chemical characteristics of impedance-positive GER and define symptom associations in sleep and wake states in symptomatic neonates. We hypothesized that frequency of impedance-positive GER events and their association with cardiorespiratory symptoms is greater during sleep. Methods Eighteen neonates underwent concurrent polysomnography with pH-impedance study. Impedance-positive GER events (weakly acidic or acidic) were categorized between sleep vs. wake states: Symptom Index = # of symptoms with GER/total symptoms*100, Symptom Sensitivity Index = # of GER with symptoms/Total GER*100 and Symptom Association Probability = [(1-Probability of observed association between reflux and symptoms)*100]). Results We analyzed 317 GER events during 116 hours of polysomnography. During wake vs. sleep respectively, the median (interquartile range) frequency of impedance-positive GER was 4.9(3.1–5.8) vs. 1.4(0.7–1.7)events/hour (P<0.001), proximal migration was 2.6(0.8–3.3) vs. 0.2(0.0–0.9)events/hour (P<0.001); Symptom Index for cardiorespiratory symptoms for impedance-positive events was 22.5 (0–55.3) vs. 6.1(0–13), P=0.04 while Symptom Sensitivity Index was 9.1(0–23.1) vs. 18.4 (0–50), P=0.04 though Symptom Association Probability was similar, (P=0.68). Conclusions Contrary to our hypothesis, frequency of GER in sleep is lesser; however, spatio-temporal and chemical characteristics of GER and symptom generation mechanisms are distinct. For cardiorespiratory symptoms during sleep, lower Symptom Index entails evaluation for etiologies other than GER disease, higher Symptom Sensitivity Index implies heightened esophageal sensitivity and similar Symptom Association Probability indicates other mechanistic possibilities.

show abstract

“…[10, 11, 51] The ICD-9 diagnosis of GERD itself is highly relevant because it indicates a clinical presumption that the infant had GERD, and reflects providers’ practice thought patterns. [52] Clinical presumptions, not only concrete diagnoses, often drive treatment decisions.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Histamine-2 Receptor Antagonist and Proton Pump Inhibitor Treatment at United States Children's Hospitals

Slaughter

Stenger

Reagan

et al. 2016

The Journal of Pediatrics

Self Cite

View full text Add to dashboard Cite

Objective To determine treatment frequency and duration of H2RA/PPI use among infants hospitalized within US children’s hospital NICUs and evaluate diagnoses/demographic factors associated with use. Study design We retrospectively analyzed a cohort of NICU infants admitted to 43 US children’s hospitals within the Pediatric Health Information System (PHIS) database between January 2006-March 2013 to determine H2RA/PPI treatment frequency, timing/duration of treatment, factors associated with use, percent of infants remaining on treatment at discharge, and inter-hospital prescribing variation. We used a modified Poisson regression to calculate the adjusted probability of infants ever receiving H2RAs/PPIs in relation to diagnosis, gestation, and sex. Results Of the 122,002 infants evaluated, 23.8% (n=28,989) ever received an H2RA or PPI; 19.0% received H2RAs (n=23187) and 10.5% (n=12823) received PPIs. Extremely preterm infants and term infants were the most likely to receive H2RA and PPI treatment. Infants with GERD [relative risk (RR): 3.13] and congenital heart disease (RR=2.41) had the highest H2RA/PPI treatment probabilities followed by those with an ENT diagnoses (RR=2.34; p<0.05). The majority of treated infants remained treated at discharge. Conclusion Despite limited evidence and increasing safety concerns, H2RAs/PPIs are frequently prescribed to extremely preterm neonates and those with congenital anomalies and continued through discharge. Our findings support the need for innovative studies to examine the comparative effectiveness and safety of H2RA/PPIs versus no treatment in these high-risk neonatal populations.

show abstract

Practice Variance, Prevalence, and Economic Burden of Premature Infants Diagnosed With GERD

Cited by 62 publications

References 21 publications

Respiratory Events in Infants Presenting with Apparent Life Threatening Events: Is There an Explanation from Esophageal Motility?

Respiratory Events in Infants Presenting with Apparent Life Threatening Events: Is There an Explanation from Esophageal Motility?

The Role of Sleep in the Modulation of Gastroesophageal Reflux and Symptoms in NICU Neonates

Neonatal Histamine-2 Receptor Antagonist and Proton Pump Inhibitor Treatment at United States Children's Hospitals

Contact Info

Product

Resources

About