Gastro-Esophageal Reflux in the Newborn: Pathologic Event or Does Spit Happen?

Infants admitted to Neonatal Intensive Care Units (NICUs) are among the most vulnerable patients in medicine and are at risk for a variety of morbidities, many of which require pharmacologic therapy. Gastroesophageal Reflux Disease (GERD) is a common diagnosis in the NICU patient population and may or may not represent a truly pathologic process. Regardless, pharmacologic therapy is provided to many infants, who are already exposed to an inordinate number of pharmacologic agents, of which most are off label and have an inadequate evidence base to establish either efficacy or safety. Furthermore, as infancy represents a time of dramatic growth and development, many conditions resolve over time, making treatment unnecessary and potentially dangerous. Infants with GERD, especially those born prematurely, exemplify the complexity of attempting pharmacologic therapy with unproven consistent benefit versus “watching and waiting.” The following will present physiology of GERD, gastrointestinal tract anatomy and development as well as options for pharmacologic and non-pharmacologic therapies.