Gastroesophageal Reflux (GER) in the Preterm Baby

Gastroesophageal reflux (GER) is very common among preterm infants, but its real frequency is not well established. GER may be obvious, manifesting with regurgitations or emesis or more difficult to detect when associated with general symptoms such as apnea, bradycardia, pallor, oxygen desaturation, severe malaise, feeding difficulties with weight loss or poor growth (failure to thrive), crying, hematemesis, and melena. The origin probably resides in motor problems in some and in cow’s milk allergy in others. Diagnosis is difficult to make, in the absence of reference values. Impedancemetry coupled to a pH probe is interesting since reflux is frequently nonacid. The treatment should always be conservative and stepwise. None of the drugs used are licensed in this age range and some have severe adverse effect.