Estudo da monitorização prolongada do pH esofágico em recém-nascidos pré-termo com suspeita clínica de doença do refluxo gastroesofágico

Abstract

Gastro-esophageal Reflux Disease (GERD) resulting from acid reflux can be diagnosed by prolonged esophageal pH monitoring. This examination in the preterm newborns (PTNBs) seeks to establish some relationship between GERD and nonspecific symptoms. This study aimed to evaluate the esophageal pH monitoring in PTNBs hospitalized with clinically suspected of GERD. In a prospective cross-sectional study esophageal pH monitoring was performed in PTNBs with clinical suspicion of GERD, gestational age less than 37 weeks and birth weight less than 2000 grams, from February 2010 to March 2011. We analyzed the clinical and demographic data, the general parameters of pH monitoring for acid reflux, the index of symptoms and the measurements for positioning the inner esophageal electrode. Of the 225 preterm infants admitted, the clinical diagnosis of GERD was assigned to 34 (15.1%). In 31 (93.9%) was found reflux index (RI) >10% and 12 (38.7%) linking the RI >10% and oscillatory index <15%, increasing the reliability of the results of RI. The mean (standard deviation) number of long refluxes and the time of the longest reflux were respectively 19.3 (9.4) and 69.2 minutes (33.2), with strong positive correlation between RI (r = 0.77 and r = 0.78, p <0.05, respectively). The association of reflux with oxygen desaturation occurred in 8 (30.8%) PTNBs. The phasic pattern of the pH monitoring tracing, suggesting allergy to cows milk protein was found in 5 (15.1%) examinations. The positioning of the inner esophageal electrode, by using the Strobel s formula and PTNBs equations for weight was highly positive correlated with fluoroscopy (r = 0.79 and r = 0.77, p <0.05, respectively). There was an expressive RI positivity indicating abnormal acidification of the esophagus in most patients clinically suspected of having GERD. Consider the other parameters used in this study for analysis of esophageal pH monitoring in PTNBs can be helpful.