Behavior and gastroesophageal reflux in the premature neonate

Background: The belief that behavioral observations assist in the clinical diagnosis of gastroesophageal reflux (GER) disease in premature neonates ha s not been formally tested. The purpose of this study was to determine whet her esophageal acidification was associated with a recognizable pattern of behavioral changes in these infants. Methods: The behavior of 14 healthy premature infants was recorded by a vid eo camera while esophageal pH was simultaneously monitored. For each of 20 acid GER episodes recorded, a 10-minute video epoch, encompassing the onset of acid GER and lasting at least 4 minutes after the onset of GER, was exa mined. Two independent observers each scored reflux-associated epochs of "g eneral" infant behavior and behavior previously shown to be indicative of r eflux in normal term infants. Results: The occurrence of esophageal acidification due to reflux did not s ignificantly alter scores for general behavior. Infants frequently demonstr ated reflux-specific behavior, including discomfort, head retraction, and m outhing; however, none of these behavioral patterns was temporally associat ed with the occurrence of acid GER. Conclusions: These data indicate that reflux-specific behavioral criteria, established in older term infants, may be inappropriate as diagnostic crite ria for GER in premature neonates and may lead to the unnecessary use of an tireflux therapy. (C) 2000 Lippincott Williams & Wilkins, Inc.