Development of an Observational Instrument to Assess Gastro-Esophageal Reflux Disease in Premature Infants

Authors

  • Susanne Georgsson Öhman Neonatal Unit, Astrid Lindgrens Children’s Hospital, Danderyd Karolinska University Hospital, Sweden
  • Christina Sandberg Department of Women’s and Children’s Health, Karolinska Institutet, Sophiahemmet University, Sweden

DOI:

https://doi.org/10.6000/1929-4247.2014.03.02.3

Keywords:

Premature infants, GERD symptoms, and observation instruments.

Abstract

Background: Premature infants are at increased risk of developing Gastroesophageal Reflux Disease (GERD), which for these children is associated with a number of severe symptoms. There is great need for effective instruments and clear symptom criteria to assess the presence and degree of severity of GERD.

Aim: To develop and pilot test an observation instrument for early detection of symptoms of GERD in premature infants.

Method: A combination of three research methods was used – systematic literature review, observation instrument development and a pilot test.

Results: The systematic review identified specific symptoms of GERD. The development of the observational instrument started with the establishment of concordance between the criteria of symptoms according to the literature review and to NIDCAP, “Newborn Individualized Developmental Care and Assessment Program”. In the pilot test the criteria of symptoms were revised by comparing the result and the criteria between infants that clinically were estimated to have had a reflux problem and the ones who did not.

Conclusion: An observation instrument was developed. The clinical evaluation by a pilot test showed that the instrument could be useful to record significant symptoms and combinations of symptoms that may occur in premature infants assessed as having reflux problems.

References

Kleinman L, Revicki DA, Flood E. Validation Issues in Questionnaires for Diagnosis and Monitoring of Gastroesophageal reflux Disease in Children. Current Gastroenterology Reports 2006; 8 (3): 230-6. http://dx.doi.org/10.1007/s11894-006-0080-y

Tufts G. Primary Care of the Premature Infant. The American Journal for Nurse 172. Practitioner Observation Report: A Behavioral Rating Instrument for Juvenile Delinquents in Residential Care. J Clin Psychol 2004; 58 (9): 1103-17.

Kleinman L, Rothman M, Strauss R, et al. The Infant Gastroesophageal Reflux Questionnaire Revised: Development and Validation as an Evaluate Instrument. Clin Gastroenterology and Hepatology 2006; 4: 588-96. http://dx.doi.org/10.1016/j.cgh.2006.02.016

Poets CF. Gastroesophageal Reflux: A Critical Review of Its Role in Preterm Infants. Pediatrics 2004; 113 (2): 128-32. http://dx.doi.org/10.1542/peds.113.2.e128

Cavataio F, Guandalini S. Gastroesophageal Reflux. In S. Guandalini (Eds.), Essential Pediatric Gastroenterology, Hepatology, and Nutrition. (ss.157-73). United States of America: McGraw-Hill Medical Publishing Division; 2005.

Fletcher AB, Avery GB. Nutrition for full-term and preterm infants: Meeting normal and exceptional needs. Postgrad Med 1984; 75 (1): 113-22.

Lawson M. Gastro-oesophageal reflux in infants: an evidence-based approach. British J Community Nursing 2003; 8 (7): 296-300.

Nelson SP, Chen EH, Syniar GM, Christoffel KK. Prevalence of Symptoms of Gastroesophageal Reflux During Infancy: A Pediatric Practice-Based Survey. Arch Pediatr Adolesc Med 1997; 151: 569-72. http://dx.doi.org/10.1001/archpedi.1997.02170430035007

Feranchak AP, Orenstein SR, Cohn JF. Behaviors Associated With Onset of Gastroesophageal Reflux Episodes in Infants: Prospective Study Using Split-Screen Video and pH Probe. Clin Pediatr 1994; 33: 654-61. http://dx.doi.org/10.1177/000992289403301104

Condino AA, Sondheimer J, Pan Z, Gralla J, Perry D, O´Connor JA. Evaluation of Infantile Acid and Nonacid Gastroesophageal Reflux Using Combined pH Monitoring and Impedance Measurement. J Pediatr Gastroenterol Nutr 2006; 42: 16-21. http://dx.doi.org/10.1097/01.mpg.0000188008.66752.72

Mason DB. Gastroesophageal Reflux in Children: A Guide for the Advanced Practice Nurse. Pediatric Advanced Practice Nursing 2000; 35 (1): 15-36.

Arguin AL, Swartz MK. Gastroesophageal reflux in Infants: A Primary Care Perspective. Pediatr Nurs 2004; 30 (1): 45-51.

Catto-Smith AG. Gastroesophageal reflux in children. Aust Fam Physician 1998; 27 (6): 465-73.

Gilles C. Nonsurgical Management of the Infant With Gastroesophageal Reflux and Respiratory Problems. J Am Acad of Nurse Pract 1991; 3 (1): 11-16. http://dx.doi.org/10.1111/j.1745-7599.1991.tb01053.x

Jones SP. Relationship Between Apnea and GER: What Nurses Need to Know. Pediatr Nurs 1992; 18 (4): 413-18.

Fox D, Bignall S. Management of Gastrooesophageal Reflux. Pediatr Nurs 1996; 8 (1): 17-20.

Hlusko DL, McMurray J. Gastroesophageal Reflux: treatment and Nursing care. Neonatal Network 1991; 9 (5): 33-36.

Gracey K. Discerning Differences: Gastroesophageal Reflux and Gastroesophageal Reflux Disease in Infants. Adv Neonatal Care 2004; 4 (4): 235-47. http://dx.doi.org/10.1016/j.adnc.2004.05.006

Sterling CE, Jolley SG, Besser AS, Matteson-Kane M. Nursing Responsibility in the Diagnosis, Care, and Treatment of the Child With Gastroesophageal Reflux. J Pedr Nurs 1991; 6 (5): 331-36.

Kelly M. Primary Care Issues for the Healthy Premature Infant. J Pedr Health Care 2006; 20: 293-99. http://dx.doi.org/10.1016/j.pedhc.2006.01.002

Peter CS, Sprodowski N, Ahlborn V, et al. Inter- and Intraobserver Agreement for Gastroesophageal Reflux Detection in Infants Using Multiple Intraluminal Impedance Biol Neonate 2004; 85: 11-14.

Omari TI, Haslam RR, Lundborg P, Davidsson GP. Effect of Omeprazole on Acid in Preterm Infants With Pathological Acid Reflux. J Pediatr Gastroenterol Nutr 2007; 44: 41-44. http://dx.doi.org/10.1097/01.mpg.0000252190.97545.07

Martin P, Bateson P. Measuring Behaviour. An Introductory Guide. Cambridge, University Press; 1986.

Liberati A. et al. The PRISMA Statement for Reporting Systematic Reviews and META-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration. PLOS Medicine 2009; 7 (7): 1-27.

Evans D, Pearson A. Systematic reviews of qualitative research. Clinical Effectiveness in Nursing 2001; 5: 111-19. http://dx.doi.org/10.1054/cein.2001.0219

Goodman C. Literature Searching and Evidence Interpretation for Assessing Health Care Practices Stockholm: SBU; 1993.

Sandelowski M, Docherty S, Emden C. Qualitative Metasynthesis: Issues and Techniques. Res Nurs Health 1997; 20: 365-71. http://dx.doi.org/10.1002/(SICI)1098-240X(199708)20:4<365::AID-NUR9>3.0.CO;2-E

De Groot L, Hopkins B, Touwen BC. A Method to Assess the Development of Muscle Power in Preterms After Term Age. Neuropediatrics 1992; 23: 172-79. http://dx.doi.org/10.1055/s-2008-1071336

Waltz CF, Strickland OL, Lenz ER. Measurement in Nursing and Health Research, Third Edition. New York, Springer Publishing Company, Inc.; 2005.

Als H. A Synactive model of Neonatal Behavioral Organisation: Framework for the Assessment of Neurobehavioral Development in the premature Infant and for Support of Infants and Parents in the Neonatal Intensive Care Environment. Physical and Occupational Therapy in Pediatrics 1986; 6: 3-55. http://dx.doi.org/10.1080/J006v06n03_02

Peirce AG. Measurement Instruments. In L.A. Talbot (Ed), Principles and Practice of Nursing Research (ss 292-316). St. Louis, Missouri, Mosby-Year Book, Inc.; 1995.

Bhat RY, Rafferty GF, Hannam S, Greenough A. Acid Gastroesophageal Reflux in Convalescent Preterm Infants: Effect of Posture and Relationship to Apnea. Pediatric Research 2007; 62(5): 620-23. http://dx.doi.org/10.1203/PDR.0b013e3181568123

Corvaglia L, Ferlini M, Rotatori R, et al. Starch thickening of human milk is ineffective in reducing the gastroesophageal reflux in preterm infants: A crossover study using intraluminal impedance. J Pediatr 2006; 148: 265-68. http://dx.doi.org/10.1016/j.jpeds.2005.09.034

Corvaglia L, Rotatori R, Ferlini M, Aceti A, Ancora G, Faldella G. The Effect of Body Positioning on Gastroesophageal Reflux in Premature infants: Evaluation by Combined Impedance and pH Monitoring. J Pediatr 2007; 151 (6): 591-96. http://dx.doi.org/10.1016/j.jpeds.2007.06.014

Ewer AK, Durbin GM, Morgan ME, Booth IW. Gastric emptying and gastro- oesophageal reflux in preterm infants. Arc Dis Child 1996; 75: F117-F121.

Khalaf MN, Porat R, Brodsky NL, Bhandari V. Clinical Correlations in Infants in the Neonatal Intensive Care Unit With Varying Severity of Gastroesophageal Reflux. J Pediatr Gastroenterol Nutr 2001; 32: 45-49. http://dx.doi.org/10.1097/00005176-200101000-00014

Dhillon AS, Ewer AK. Diagnosis and management of gastro-oesophageal reflux in preterm infants in neonatal intensive care units. Acta Paediatr 2004; 93: 88-93. http://dx.doi.org/10.1111/j.1651-2227.2004.tb00680.x

Ewer AK, James ME, Tobin, JM. Prone and left lateral positioning reduce gastro-oesophageal reflux in preterm infants. Arc Dis Child 1999; 81: F201- F205.

Jadcherla SR, Gupta A, Fernandez S, et al. Am J Gastroenterol 2008; 103: 720-28. http://dx.doi.org/10.1111/j.1572-0241.2007.01748.x

Morigeri C, Bhattacharya A, Mukhopadhyay K, Narang A, Mittal, BR. Radionuclide scintigraphy in the evaluation of gastroesophageal reflux in symptomatic and asymptomatic pre-term infants. European Nuclear Medicin Mol Imaging 2008; 35: 1659-1665. http://dx.doi.org/10.1007/s00259-008-0752-y

Akinola E, Rosenkrantz TS, Pappagallo M, Mckay K, Hussain N. Gastroesophageal Reflux in Infants < 32 Weeks Gestational Age at Birth: Lack of Relationship to Chronic Lung Disease. Am J Perinatol 2004; 21 (2): 57-62. http://dx.doi.org/10.1055/s-2004-820512

Snel A, Barnett CP, Cresp TL, et al. Behavior and Gastroesophageal Reflux in the Premature Neonate. J Pediatr Gastroenterol Nutr 2000; 30 (1): 18-21. http://dx.doi.org/10.1097/00005176-200001000-00012

Corvaglia, L, Zama D, Gualdi S, Ferlini M, Aceti A, Faldella, G. Gastroesophageal reflux increases the number of apneas in very preterm infants. Arc Dis Child – Fetal and Neonatal Edition ADC-FNN Online First, published on September 11, 2008 as 10.1136/adc.2008.143198.

Magistá AM, Indrio F, Baldassarre M, et al. Multichannel intraluminal impedance to detect relationship between gastroesophageal reflux and apnoea of prematurity. Digestive and Liver Disease 2007; 39 (3): 216-21. http://dx.doi.org/10.1016/j.dld.2006.12.015

Poblano A, Marquez A, Hernadez G. Apnea in Infants. Indian J Pediatr 2006; 73(12): 1085-88. http://dx.doi.org/10.1007/BF02763050

Peter CS, Sprodowski N, Bohnhorst B, Silny J, Poets CF. Gastroesophageal Reflux and Apnea of Prematurity: No Temporal Relationship. Pediatrics 2002; 109 (1): 8-11. http://dx.doi.org/10.1542/peds.109.1.8

Di Fiore JM, Arko M, Whitehouse M, Kimball A, Martin RJ. Apnea Is Not Prolonged by Acid Gastroesophageal Reflux in Preterm Infants. Pediatrics 2005; 116 (5): 1059-63. http://dx.doi.org/10.1542/peds.2004-2757

Misra S, Macwan K, Albert V. Transpyloric feeding in gastroesophageal-reflux-associated apnea in premature infants. Acta Paediatr 2007; 96: 1426-29. http://dx.doi.org/10.1111/j.1651-2227.2007.00442.x

Omari TI, Barnett C, Snel A, et al. Mechanisms of gastroesophageal reflux in healthy premature infants. J Pediatr 1998; 133 (5): 1-9. http://dx.doi.org/10.1016/S0022-3476(98)70106-4

López-Alonso M, Moya MJ, Cabo JA, Ribas J, Macías M.C, Silny J, et al. Twenty-Four-Hour Esophageal Impedance-pH Monitoring in Healthy Preterm Neonates: Rate and Characteristics of Acid, Weakly Acidic, and Weakly Alkaline Gastroesophageal Reflux. Pediatrics 2006; 118 (2): 299-308. http://dx.doi.org/10.1542/peds.2005-3140

Doshi A, Bernard-Stover L, Kuelbs C, Castillo E, Stucky E. Apparent life-threating event admissions and gastroesophageal reflux disease: the value of hospitalization. Pediatric Emerg Care 2012; 28 (1): 17-21. http://dx.doi.org/10.1097/PEC.0b013e31823ed6f8

Poets CF, Brockmann PE. Myth: gastroesophageal reflux is a pathological entity in the preterm infant. Semin Fetal Neonatal Med 2011; 16 (5): 259-63. http://dx.doi.org/10.1016/j.siny.2011.05.001

Suáres-Morán, E, et al. Influence of central apnea in the preterm newborn with gastroesophageal reflux disease. Cir Cir 2011; 79 (6): 511.

Zimbric G, Bonkowski JL, Jackson WD, Maloney CG, Sirastava, R. Adverse outcomes associated with gastroesophageal reflux disease are rare following an apparent lifethreatening event. J Hosp Med 2012; 24.

Kernberg PF, Chazan SE, Normandin L. The Children´s Play Therapy Instrument (CPTI). Description, Development and Reliability Studies. J Psychotherapy Practice and Research 1998; 7 (3): 196-207.

Cranston Andersson G, Radjenovic D, Chiu S-H, Conlon, Lane AE. Development of an Observational Instrument to Measure Mother-Infant Separation Post Birth. J Nurs Meas 2004; 12 (3): 215-34. http://dx.doi.org/10.1891/jnum.12.3.215

Debillon T, Zupan V, Ravault N, Magny J-F, Dehan M. Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants. Arch Dis Child Fetal Neonatal Ed 2001; 85: F36-F41. http://dx.doi.org/10.1136/fn.85.1.F36

Li HC, Lopez V. Children`s Emotional Manifestation Scale: development and testing. J Clin Nurs 2004; 14: 223-29. http://dx.doi.org/10.1111/j.1365-2702.2004.01031.x

Downloads

Published

2014-05-28

How to Cite

Öhman, S. G. ., & Sandberg, C. (2014). Development of an Observational Instrument to Assess Gastro-Esophageal Reflux Disease in Premature Infants. International Journal of Child Health and Nutrition, 3(2), 84–92. https://doi.org/10.6000/1929-4247.2014.03.02.3

Issue

Section

General Articles