Análise da monitorização simultânea do ph gástrico e esofágico por 24 horas, como método diagnóstico do refluxo gastroesofágico ácido, em recém-nascidos sob alimentação láctea exclusiva

Abstract

Background: Gastroesophageal reflux (GER) in neonates, especially in preterm infants, is a frequent cause of digestive and/or respiratory clinical signs that for times display these patients to the death risk. The continuous esophageal pH monitoring (CEpHM) for 24 hours, a good method for the diagnosis, may be normal, in these babies, because the technique identifies the acid reflux episodes and the gastric content pH may be buffered by frequent milk feedings. Aim: To study gastric and esophageal pH for 24 hours in neonates with clinical signs of GER, to verify the possible effect of the exclusive milk feeding on the gastric acidity, intervening on the detection of acid GER and to correlate the clinical manifestations presented during the gastric and esophageal pH monitoring. Methodology: Thirty one newborns (17 males and 14 females) with morbity events and/or hypoxemia, correlates to feedings, had been submitted to simultaneous gastric and esophageal pH monitoring (GEpHM) for 24 hours with non-invasive monitoring of cardiac frequency, oximetry, arterial pressure and eletrocardiography through multiparametric monitor (Dixtal DX 2010). The NB were in average 31 (26 38) weeks GA, 1342,58 g (± 643,96) and 39 cm (± 4,49). When submitted to 24-h CEGpHM, they were 39,29 (± 19,.87) days old, 37 (29 weeks and 3 days 17 days after 40 weeks) weeks, 1852,42 (± 737,1) g and 42,2 (± 4,4) cm; were fed breastmilk and formula. Newborns with abnormal % TEpH < 4, were denominated GROUP 1 and with normal % TEpH < 4, GROUP 2, with analysis of other GEpHM parameters. Another analysis was performed between newborns under (GROUP A) and upper (GROUP B) 37th weeks postmenstrual age, postnatal.Results: The mean gastric pH was 4,13 (± 1,07); %TGpH < 4, 47,45% (± 19,88); %TEpH < 4, 9,14 (± 6,96) and % TGpH >4 after meal, 85,96 (± 19,4) minutes. GROUP 1(G1) and GROUP 2 (G2) included eight and 23 NB, respectively. A significant differences were observed between %TEpH < 4, % TGpH >4 after meal and mean and maximum gastric pH between the two groups. 23 NB were exclusively fed with simple gavage, and 15 were from GROUP 2. NB from GROUP B presented post-prandial T%GpH > 4 higher than NB from GROUP A (p = 0,024). A correlation was observed between lower GA on the day of testing and higher mean %TEpH < 4 (p = 0,005), and between lower post-prandial %TGpH > 4 and higher %TEpH < 4 (p = 0,008). Conclusion: The 24h CEGpHM may contribute to the study of GERD by allowing the analysis of the influence of gastric pH on the disease, in newborns with exclusive milk feeding and the test showed that 25,81% of the newborns with clinical symptoms of GER had acid GER. The daily register allows investigation of the temporal relationship between a clinical situation with %TEpH < 4 altered at diagnosis of acid GER. In the present study, orogastric tube doesnt affect gastroesophageal reflux.