Gastroesophageal endoscopic findings and gastrointestinal symptoms in preterm neonates with and without perinatal indomethacin exposure

Background: The aim of this study was to investigate whether perinatal indo methacin treatment has effects on the development of esophageal and gastric lesions in preterm infants and to evaluate other potential etiologic facto rs behind these lesions. Methods: Sixty-nine infants were born at less than 33 weeks' gestation. Fer ry-five of these infants underwent treatment with perinatal indomethacin (s tudy group) and 24 did not (control group). All underwent upper gastrointes tinal tract endoscopy and biopsy during the neonatal period. The correlatio n between gastrointestinal symptoms, abnormal endoscopic findings, and the factors correlating with the development of esophageal and gastric mucosal lesions was evaluated. Results: Abnormal endoscopic findings were equally common in the study grou p (77.8%) and in controls (83.3%). There was no dependence between gastroin testinal symptoms and endoscopic findings because only 15 infants (21.7%) w ere symptomatic before endoscopy. The interval between endoscopy and the la st perinatal indomethacin dose correlated significantly,with abnormal esoph ageal findings and gastric mucosal lesions. Shorter duration of enteral fee ding before endoscopy correlated with greater risk of abnormal esophageal f indings. Older gestational age and need of ventilator treatment at the time of endoscopy remained the risk factors associated with abnormal gastric fi ndings. Conclusions: Esophageal and gastric lesions diagnosed by endoscopy correlat e poorly with the,gastrointestinal symptoms of patients. Short duration of enteral feeding seems to be correlated with an increased risk of esophageal mucosal lesions, increasing gestational age and ventilator treatment with gastric mucosal lesions, and perinatal indomethacin with esophageal and gas tric mucosal lesions in preterm infants. Ventilator-treated preterm infants not receiving enteral nutrition and patients with indomethacin exposure mi ght benefit from ulcer prophylaxis.