The American Academy of Pediatrics will release a clinical report titled, “Diagnosis and Management of Gastroesophageal Reflux in Preterm Infants,” in the July 2018 issue of Pediatrics (published online June 18). The report offers guidance on gastroesophageal reflux (GER), which is defined as the passage of gastric contents into the esophagus—an almost universal phenomenon in preterm infants.

While it is a common diagnosis in the neonatal intensive care unit, the treatment for it varies widely by site. Infants diagnosed with GER, also called reflux, often have longer hospital stays and higher hospital costs than other infants, and yet many treatments for GER are of questionable value, according to research. Clinical signs frequently attributed to GER may include feeding intolerance or aversion, poor weight gain, frequent regurgitation, and behavioral signs such as irritability and arching after a feeding.

Conservative measures to control reflux include left lateral body position, head elevation, and feeding regimen changes, but none have been shown to reduce clinically assessed signs of GER in the preterm infant. There is a lack of evidence that medication provides relief from GER as well, and emerging evidence shows the pharmacologic treatment options may even be harmful. The AAP recommends that medications for GER be used sparingly, if at all, in preterm infants. The academy describes GER in the preterm infant as a normal developmental phenomenon that will usually resolve with maturation.