676 - Pathological Esophageal PH-Impedance In Neonates And Young Infants: Identification Of Clinical Predictors

Publication Number: 4661.676

Noemi Belli, Ospedale dei Bambini Vittore Buzzi, Milano, Lombardia, Italy; Fabio Meneghin, NICU Vittore Buzzi Children's Hospital, Milan, Lombardia, Italy; Davide Gori, University of Bologna, Bologna, Emilia-Romagna, Italy; Gianluca Lista, Asst fbf Sacco, Milan, Lombardia, Italy; Francesca Castoldi, NICU V.Buzzi Children's Hospital, Milan, Lombardia, Italy; Enrica Lupo, Children's Hospital Buzzi, Milano, Lombardia, Italy; Sara Gatto, Childrens’ Hospital Vittore Buzzi, Milan, Lombardia, Italy; Valeria Anna Manfredini, Buzzi Hospital, Milano, Lombardia, Italy; Giulia Cannata, Vittore Buzzi Children's Hospital, Milan, Lombardia, Italy; Massimo Agosti, University of Insubria, Varese, Lombardia, Italy; Silvia Salvatore, University of Insubria, Varese, Lombardia, Italy; Alessia Lamera, Università degli Studi dell'Insubria, Villa Cortese, Lombardia, Italy; Giulio Beretta, Università degli studi di genova, Seregno, Lombardia, Italy; Chiara Nava, Università degli studi di Milano, Milano, Lombardia, Italy; Sofia Fatima Giuseppina Colombo, Buzzi Children’s Hospital -University of Milan, Milano, Lombardia, Italy; Petrina Bastrenta, NICU V.Buzzi Children's Hospital, milano, Lombardia, Italy; Silvia Bianchi, Buzzi Children Hospital Milan, MILANO, Lombardia, Italy; Valentina Pivetti, Ospedale dei Bambini V.Buzzi, Milan, Lombardia, Italy; Paola Azzurra La Verde, NICU VITTORE BUZZI CHILDRENS' HOSPITAL MILAN, Milan, Lombardia, Italy; Raffaele Masotina, NICU Vittore Buzzi Chlidren Hospital, Milan, Milano, Lombardia, Italy; Samantha Rossi, Vittore Buzzi Children's Hospital, Milan, Lombardia, Italy; Anna F. Moscatiello, Ospedale dei Bambini Vittore Buzzi, Milan, Lombardia, Italy; Francesco Cavigioli, NICU V.Buzzi Children's Hospital Milan Italy, Milan, Lombardia, Italy

Background: The diagnosis of Gastroesophageal reflux disease (GERD) in neonates and infants is still challenging. Esophageal pH impedance (MII-pH) is recommended but is not frequently performed; empirical acid inhibitors are overprescribed.

Objective: To develop a predictive model to identify risk factors for GERD in early life.

Design/Methods: We retrospectically included all infants (0-5 months) who underwent a MII-pH because of persistent unexplained distress, cardiorespiratory or gastrointestinal symptoms in two pediatric hospitals between January2015-February2025. Neonatal data, symptoms, comorbidities, diet, treatment and MII-pH parameters were considered. According to previous neonatal studies, MII-pH was defined as normal when acid exposure was < 3%, SI < 50% SAP < 95%. Stepwise backward and stepwise mixed models were used to define the variables to include in the multiple logistic regression based on univariate analysis, parsimony and biological plausibility.

Results: We enrolled 279 subjects (136 males, mean age 47.9±38.9 days, range 2-177 days; mean GA 41+6 ±5 wks range 30-58 wks). Abnormal MII-pH were 157 (56.3%). Distribution of MII-pH parameters are shown in figure 1. Regression analysis showed abnormal MII-pH results significantly associated with prematurity (OR=4.54; p=0.005) and cardiovascular/hematological comorbidities (OR=2.33; p=0.058). Acid reflux was significantly associated to prematurity (OR=5; p=0.003), ventilation (OR=2; p=0.018) and cardiovascular/hematological comorbidities (OR=2; p=0.027). Regurgitation, poor growth, arching, and crying were not significant for abnormal MII-pH. No specific symptom was associated with positive SAP; respiratory symptoms were significantly associated with positive SI (OR=3.13; p=0.012); regression analyses of the relationship between variables and pathological outcomes at MII-pH are shown in Figure 2. At follow-up visit (214 infants, 76.7%), absence of treatment was associated with persistent symptoms (OR=1.28; p=0.018).

Conclusion(s): In our cohorts of neonates and young infants, prematurity, cardiovascular and hematological comorbidities and need of ventilation represented significant risk factors for GERD as detected by MII-pH. Our model could enable more accurate identification of newborns/infants with GERD who are therefore eligible for targeted diagnosis and appropriate treatment, thereby reducing the empirical use of proton pump inhibitors (PPIs).

MII-pH results distribution


Regression analysis of the relationship between variables and pathological outcomes at MII-pH.
GA: gestational age