IMPACT OF GASTROESOPHAGEAL REFLUX ON GROWTH AND HOSPITAL STAY IN PREMATURE-INFANTS

Background: Gastroesophageal reflux (GER) is associated with failure t o thrive in term infants with severe GER; however, this association ha s not been shown in premature infants. A retrospective case-control st udy of growth velocities, caloric intake, and length of hospital stay in premature infants with GER was conducted to determine the impact of GER on their growth. Methods: Twenty-three patients with clinically s ignificant GER were identified from a database containing records for all infants admitted to the University of Connecticut Health Center Ne onatal Intensive Care Unit. Patients and control subjects (n = 23) wer e matched for gestational age, birth weight, gender, and severity of b ronchopulmonary dysplasia. Each infant's average weekly weight gain an d average weekly caloric intake were calculated, using daily bedside n ursing flow sheets. Comparisons were also made of the number of days i t took each infant to achieve full oral feedings, number of days from full oral feedings to discharge, and length of hospital stay. Results: There were no significant differences between patients and control su bjects for each week in average weekly weight gain, caloric intake, gr ams gained per calorie given, or weekly increments gained in length an d head circumference. There were, however, significant differences in time required to achieve full oral feedings (32 +/- 13 days versus 19 +/- 12 days; p < 0.0008) and length of hospital stay (99 +/- 27 days v ersus 70 +/- 31 days; p < 0.002) as well as postmenstrual age (PMA) at discharge (43 +/- 3 weeks versus 39 +/- 3 weeks, p < 0.001). Conclusi ons: GER did not have a significant impact on caloric intake, effectiv e use of calories, or growth velocities in the study population. It is more likely that the constant monitoring of weight gain and caloric i ntake while in the intensive care environment protects against the fai lure to thrive often seen in older infants with GER. Premature infants with GER had a significantly increased length of hospital stay. More aggressive medical management and consideration of alternative feeding strategies may help facilitate discharge for premature infants diagno sed with GER.