DISTINCT FEATURES OF UPPER GASTROINTESTINAL ENDOSCOPY IN THE NEWBORN

Between January 1987 and December 1990, 293 upper GI endoscopic proced ures were performed in 219 neonates <1 month of age. No lesion was fou nd in 57 cases (26%; group 1), whereas esophagitis was present in 158 cases, alone in 45 cases (20.6%; group 2) and associated with gastriti s in 113 cases (51.8%; group 3). The association of esophagitis with g astritis seems to be a specific feature of neonates and not older chil dren. The presence of gastritis with esophagitis suggests that a prima ry peptic mechanism is unlikely to explain all endoscopic findings, al though the presence of such a mechanism secondary to esophagitis could contribute to the esophageal lesions. Acute fetal distress was more f requent in group 3 than in the other groups. Symptoms associated with endoscopic lesions in groups 2 and 3 were, respectively, malaise (38 a nd 42%), hematemesis (4 and 35%), frequent regurgitation (45 and 26%), and difficult feeding and/or failure to thrive (26 and 24%). In Group 3, minor symptoms often led to the diagnosis of severe mucosal lesion s, and antireflux therapy elicited prompt relief of clinical symptoms. The causes of neonatal esophagogastritis remain unknown. Wide use of endoscopy in the presence of discrete clinical abnormalities is likely to considerably improve the clinical condition of some children in th eir first days of life.