Abstract
Esophagitis (E) is being recognized more frequently in the pediatric population; however, the diagnosis appears to be rare during the neonatal period. Over the last 2 years, 8 seriously ill neonates were evaluated for the possibility of E. Indications for esophagogastroscopy (EGS) included irritability or arching with feeds (3/8), refusal of oral feeds (4/8), frequent gastric aspirates or emeses (6/8), and the presence of blood in aspirates (6/8). Gestational age ranged from 25-32wks. 7/8 had nasogastric (NG) tubes for 3-7 1/2 mo. and the 8th had a gastrostomy tube (GT) s/p NEC. 5/8 patients were on long term theophylline therapy and 3 were on ventilators. At EGS, wt ranged from 1590-5390gms. All 8 had evidence of erosive E with severe mucosal edema, erythema, exudation and ulceration. 4/9 had pseudopolyps, 2 had gastric outlet obstruction secondary to a pancreatic rest or a pyloric web subsequently documented at surgery. Of the remaining 6, 4 improved after removal of the NG tube and treatment with cimetidine and/or antacids. 1 died due to the underlying disease and 1 required a GT because of poor oral intake. 7/8 had no complications during the EGS; only 1 patient had a transient bradycardia during intubation of the esophagus.
In conclusion, EGS is a useful and safe test to evaluate neonates with irritability, refusal of feeds and repeated or bloody gastric aspirates. Our findings suggest that NG tube trauma, as well as rare causes of gastric outlet obstruction, may be responsible for these symptoms which are often seen in premature infants.
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Hupertz, V., Czinn, S., Gregory, D. et al. CLINICALLY SIGNIFICANT ESOPHAGITIS IN TUBE FED HIGH RISK NEONATES: A PREVIOUSLY UNRECOGNIZED PROBLEM. Pediatr Res 21 (Suppl 4), 270 (1987). https://doi.org/10.1203/00006450-198704010-00616
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DOI: https://doi.org/10.1203/00006450-198704010-00616