Neonatal Gastro-Esophageal Reflux Disease (GERD) Management Trial

Not Applicable

Completed

Interventions: Other: Study Arm - acid suppression plus feeding bundle
Other: Conventional arm - acid suppression only

Brief Summary: The overall purpose of the investigator's study is to evaluate the causes of and treatment for feeding difficulty in infants with Gastro-esophageal Reflux Disease (GERD). New treatments can be possible only if the cause is known. Many infants have GERD and feeding difficulties, such as sucking and swallowing problems, vomiting, or delayed emptying of the stomach. Some of these infants have difficulty in protecting their airway during feeding or during reflux, and as a result can breathe fluid into their lungs or hold their breath. Most GERD treatments are done based on experience, but there is no scientific proof that these methods work for infants. GERD and feeding difficulties can lead to longer hospitalization and more stress for the family.

In this clinical trial, the investigators are developing new methods to help with diagnosis as well as defining better treatment strategies in relieving GERD and GERD complications.

Detailed Description: Gastroesophageal reflux disease (GERD) and its troublesome complications constitute serious diagnostic and management challenges to the development of safe feeding and airway protection strategies among infants convalescing in the neonatal intensive care units; thus contributing to prolonged lengths of stay, recurrent hospitalizations, and death. GERD is frequently diagnosed by inadequate criteria, and the relative risks, benefits and indications of GERD therapies are unclear. Significant gaps in knowledge exist in understanding the complex causal or adaptive aerodigestive protective reflex mechanisms implicated in GERD in infants. The long-term goal is to improve digestive health, nutrition, and infant development through the design of simplified personalized treatment paradigms by better understanding the pathophysiology of aerodigestive reflexes.

The current objective is to conduct a prospective single center randomized blinded controlled trial comparing the short term effects of the investigators innovative feeding strategy bundle (study approach) versus standard feeding approach (conventional approach).

Recruitment & Eligibility

Inclusion Criteria

Hospitalized infants with aerodigestive or GERD symptoms
Gestational age ≤42 weeks
Premature infants are eligible at 34 weeks postmenstrual age (PMA)
Enteral or Oral Fed
Average daily total feeding volume ≥ 150ml/kg/day
Room air or supplemental oxygen of ≤1 liter/minute (LPM) and/or ≤ 35% by nasal cannula

Exclusion Criteria

Known genetic, metabolic or syndromic disease
Neurological diseases such as Grade 3 or 4 intraventricular hemorrhage (IVH) or intracranial hemorrhage (ICH) and perinatal asphyxia
Gastrointestinal malformations and surgical gastrointestinal conditions

Arm && Interventions

Group	Intervention	Description
Study	Study Arm - acid suppression plus feeding bundle	Treated with omeprazole. This group of subjects will have prescribed restricted feeding volumes, monitored feeding duration time and positioning restrictions
Conventional	Conventional arm - acid suppression only	Treated with omeprazole. This group of subjects will receive the current standard treatment for Gastro-esophageal reflux disease (GERD) which includes use of acid suppressive medication with no restrictions of the feeding volume, duration or positioning.

Primary Outcome Measures

Name	Time	Method
CLINICAL OUTCOME OF FEEDING SUCCESS	Up to 5 weeks after enrollment	The primary endpoint is the feeding success defined as achieving full oral feeds (defined as no need for tube feeds to maintain hydration and nutrition) and/or a \>/= 6 point decrease from baseline symptom score as described by the Infant-Gastro-Esophageal Reflux Questionnaire-Revised. The minimum score is 0 (no symptoms) and the maximum score is 42 (maximum symptoms). Any total score greater than or equal to 16 is considered abnormal.
MOTILITY OUTCOMES: Presence of Esophageal Peristaltic Reflexes	5 weeks	This is part of Aim 2 of this RCT, which is a mechanistic outcome designed to understand the reasons for the clinical outcome. Presence of peristaltic reflex mechanisms elicited upon esophageal provocation during esophageal manometry were compared within the groups, week-5 vs. week-0. Odds ratios (ORs) with 95% confidence interval (CI) are reported from Generalized Estimation Equation models.

Secondary Outcome Measures

Name	Time	Method
CLINICAL OUTCOME: Respiratory Outcome Measures	at discharge	Supplemental oxygen requirement at discharge was recorded for both groups
CLINICAL OUTCOMES: Growth Outcome Measure	at 5 weeks	Growth: The investigators will measure and track weight growth velocity during the study period
CLINICAL OUTCOME: Development Outcome Measures	Up to 1 year age	Feeding Milestones: The investigators will track feeding method at 1 year.