Pharmacologic therapy is added once diagnostic work up supports the clinical diagnosis and is usually in the form of a prokinetic agent such as metaclopramide and addition of an H2 blocker such as cimetadine or ranitidine if esophagitis is also suspected. Bethanecol has respiratory side effects in infants with asthma and is usually not used in the premie NICU population. Cisapride is another prokinetic drug that has the same side effects of Reglan and Bethanecol, but side effects are seen less often. In the future, treatment with Cisapride may replace Reglan as clinical experience with this drug increases. GI consult should be obtained if contemplating using this drug.
Medical management is appropriate in the infant with moderate reflux symptoms.
Medical therapy should be re evaluated after 2 months. Severe reflux symptoms which include aspiration pneumonia, recurrent failures to remain extubated, significant apnea or bradycardia, and poor weight gain, may benefit from surgical intervention. The procedure of choice is a Nissen fundoplication. Please note that the North American Society for Pediatric Gastroenterology and Nutrition is currently developing guidlines for management of GER, and once these are finalized, this current document will be reviewed with respect to consider this group's recommendations. Diagnosis and Management Flowchart Download Flowchart References Albanese, CT, Towbin, RB, Ulman, I, et al.