High prevalence of asymptomatic esophageal and gastric lesions in preterm infants in intensive care
| Autor: | Anna-Leena Kuusela, Tarja Ruuska, Riitta Karikoski-Leo, R. S. Ikonen, Markku Mäki |
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| Rok vydání: | 1993 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Neonatal intensive care unit Critical Care Biopsy Gestational Age Infant Premature Diseases Critical Care and Intensive Care Medicine Ranitidine Asymptomatic Melena Risk Factors Stress Physiological Intensive care Intensive Care Units Neonatal medicine Prevalence Birth Weight Esophagitis Humans Prospective Studies Monitoring Physiologic Acute Gastritis business.industry Esophageal disease Infant Newborn medicine.disease Gastritis Female medicine.symptom business Gastroscopes |
| Zdroj: | Critical care medicine. 21(12) |
| ISSN: | 0090-3493 |
| Popis: | OBJECTIVE To establish the prevalence of upper gastrointestinal mucosal lesions in full-term and preterm infants under stress. DESIGN A prospective, cohort study. SETTING Neonatal intensive care unit at a university teaching hospital. PATIENTS Seventeen (14 preterm, 3 term; median gestational age 29.7 wks; median birth weight 1230 g) consecutive, unselected infants treated in intensive care. INTERVENTIONS Gastroscopy, using a prototype fiberoptic gastroscope designed for newborns, was performed for the first time at the age of 3 to 7 days. Biopsy specimens were taken when possible. Ranitidine treatment and follow-up endoscopies were performed in selected patients. Blood pressure, heart rate, oxygen saturation by pulse oximeter, and the general condition of the infants were monitored at 1-min intervals during the endoscopy. Central nervous system ultrasonography examination was repeatedly performed before and after the procedure. MEASUREMENTS AND MAIN RESULTS At the time of first endoscopy, 15 of 17 infants were asymptomatic for gastrointestinal tract problems, one had melena, and one hematemesis. Upper gastrointestinal endoscopy revealed pathology in 16 (94%) infants, macroscopic esophagitis in six infants, hemorrhagic gastritis in nine infants, and gastritis with ulcers in six infants. Microscopically, the lesions were also clear. A peculiar finding was acute gastritis with cystic gland deformation ("cystic gastritis") seen in five of the infants under stress; one of these infants also had intestinal metaplasia in the gastric mucosa. Seven infants were treated with ranitidine without side-effects. Follow-up endoscopies demonstrated normalization of the lesions in five of six infants studied. The procedure, including biopsies, seemed to be safe, even for very low-birth weight infants. CONCLUSIONS Gastric mucosal lesions are highly prevalent in preterm infants in intensive care before any symptoms occur. Further research on preterm infants under stress is needed in order to determine the risk factors and optimal treatment for the esophageal and gastric mucosal lesions described here. |
| Databáze: | OpenAIRE |
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