Incidence of gastro-esophageal reflux disease in mechanically ventilated full-term Egyptian neonates by detection of pepsin in endotracheal aspirate

Abstract

BACKGROUND

Gastroesophageal reflux disease (GERD) is common among neonates, particularly those requiring mechanical ventilation. Pepsin, a reliable marker of gastric aspiration, may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.

AIM

To determine the incidence of GERD, associated risk factors, and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endotracheal aspirates (ETA).

METHODS

This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024. ETA samples were collected at three intervals: Immediately post-intubation (Sample A), 48 hours after intubation (Sample B), and just before extubation (Sample C). Pepsin concentration was measured using enzyme-linked immunosorbent assay. Clinical data, including hospital stay duration and feeding parameters, were correlated with pepsin levels.

RESULTS

Pepsin was detected in 76 (78.4%) of Sample A, 78 (81.3%) of Sample B, and 47 (68.1%) of Sample C. A significant positive correlation was found between pepsin levels and FiO₂ in Sample B (r = 0.203, P = 0.047). Prolonged hospital stay was also associated with pepsin detection in Samples B and C (P < 0.05). A negative correlation was observed between feeding amount and pepsin levels across all samples (P < 0.05).

CONCLUSION

The incidence of GERD in full-term mechanically ventilated neonates is high, correlating with pepsin levels, FiO₂, feeding intolerance, and hospital stay, highlighting the importance of early detection.

Keywords: Gastroesophageal reflux disease; Neonates; Mechanical ventilation; Pepsin; Endotracheal aspirates

Core Tip: This study evaluates the incidence of gastroesophageal reflux disease (GERD) in mechanically ventilated full-term neonates using pepsin detection in endotracheal aspirates (ETA). Conducted on 97 neonates, the study demonstrates that pepsin was detected in 76.7% of samples collected, with significant correlations between pepsin levels, FiO₂, feeding amount, and hospital stay duration. The findings highlight the association of GER episodes with feeding intolerance and prolonged hospitalization, emphasizing the importance of early GER detection through ETA pepsin measurement. These insights can guide clinical interventions to mitigate complications and improve neonatal outcomes, though further studies are warranted to explore preventive strategies and optimize care in this vulnerable population.