HIGH PREVALENCE OF ASYMPTOMATIC ESOPHAGEAL AND GASTRIC-LESIONS IN PRETERM INFANTS IN INTENSIVE-CARE

Objective: To establish the prevalence of upper gastrointestinal mucos al lesions in full-term and preterm infants under stress. Design: A pr ospective, cohort study. Setting: Neonatal intensive care unit at a un iversity teaching hospital. Patients: Seventeen (14 preterm, 3 term; m edian gestational age 29.7 wks; median birth weight 1230 g) consecutiv e, unselected infants treated in intensive care. Interventions: Gastro scopy, using a prototype fiberoptic gastroscope designed for newborns, was performed for the first time at the age of 3 to 7 days. Biopsy sp ecimens were taken when possible. Ranitidine treatment and follow-up e ndoscopies were performed in selected patients. Blood pressure, heart rate, oxygen saturation by pulse oximeter, and the general condition o f the infants were monitored at 1-min intervals during the endoscopy. Central nervous system ultrasonography examination was repeatedly perf ormed before and after the procedure. Measurements and Main Results: A t the time of first endoscopy, 15 of 17 infants were asymptomatic for gastrointestinal tract problems, one had melena, and one hematemesis. Upper gastrointestinal endoscopy revealed pathology in 16 (94%) infant s, macroscopic esophagitis in six infants, hemorrhagic gastritis in ni ne infants, and gastritis with ulcers in six infants. Microscopically, the lesions were also clear. A peculiar finding was acute gastritis w ith cystic gland deformation (''cystic gastritis'') seen in five of th e infants; under stress; one of these infants also had intestinal meta plasia in the gastric mucosa. Seven infants were treated with ranitidi ne without side-effects. Follow-up endoscopies demonstrated normalizat ion of the lesions in five of six infants studied. The procedure, incl uding biopsies, seemed to be safe, even for very low-birth weight infa nts. Conclusions: Gastric mucosal lesions are highly prevalent in pret erm infants in intensive care before any symptoms occur. Further resea rch on preterm infants under stress is needed in order to determine th e risk factors and optimal treatment for the esophageal and gastric mu cosal lesions described here.