Risk factors for severe esophageal and gastric lesions in term neonates: Acase-control study

Background: The purpose of this multicenter case-control study was to searc h for causes and risk factors related to the severe upper digestive tract l esions often seen in neonates. Methods: Case patients were full-term neonates with endoscopically confirme d severe bleeding or ulcerative lesions of the esophagus and/or stomach. Ma tched control subjects were the next infant born in the same maternity unit who met the same criteria and had no clinical abnormality land, for ethica l reasons, no endoscopy). The analysis was based on 137 case-control pairs and considered data showing the mothers' medical and obstetric background, the infants' clinical status and laboratory results, feeding details, and t he State and Trait Anxiety Inventory (STAI) questionnaire, which was used t o assess the anxiety of the mothers. Results: Cases and controls did not differ in any demographic or social fac tors. Antacid and anti-ulcer drugs were used significantly more frequently during the last month of pregnancy by case mothers than by control mothers (28% and 10%, respectively; P < 0.001). Mode of delivery was similar. Case infants more frequently experienced cardiac deceleration during labor and d elivery (28% and 12.9%; P = 0.003). Breast feeding at birth was less freque nt for case infants (36% and 49%; P = 0.05). The mean trait anxiety scores did not differ between the two groups, but the mean stare anxiety score was higher in case mothers. Multivariate logistic regression found that three factors were independently and significantly associated with esophageal and gastric lesions: use of antacid and antiulcer treatments (odds ratio [OR], 3.9; P < 0.001), cardiac deceleration (OR, 2.2; P = 0.03), and breast-feed ing (OR, 0.5; P = 0.02). Conclusions: Antacid drug use by mothers during the last month of pregnancy was associated with esophageal and gastric lesions. Breast-feeding may pla y a protective role against severe lesions in neonates.