Management of Gastroesophageal Reflux Disease in Newborns

Introduction to GERD Management

• The American Academy of Pediatrics states that there is insufficient evidence to support the routine use of any prokinetic agent, including domperidone, for the treatment of GERD in infants or older children 3, 4
• A Cochrane review on GERD therapies, including domperidone, failed to find a beneficial effect for cough and reflux symptoms 1, 2

Conservative Management

• Lifestyle and feeding modifications are the recommended first-line approach for newborns with GERD, including positioning, feeding modifications, and considering thickened feedings 5, 6, 1, 2
• These interventions should be tried for 2-4 weeks before considering pharmacologic therapy 5, 6

Pharmacologic Therapy

• If pharmacologic therapy is necessary after failed conservative measures, acid suppressants (H2RAs or PPIs) are preferred over prokinetics 3, 4, 5, 6
• H2 receptor antagonists, such as ranitidine or famotidine, are recommended as first-line medications 5
• Proton pump inhibitors may be considered for moderate to severe symptoms or confirmed erosive esophagitis, but caution is warranted due to the risk of adverse effects 3, 4, 5, 6

Important Considerations

• Overuse of acid suppressants in infants with reflux is a concern, as it may increase the risk of community-acquired pneumonia, gastroenteritis, candidemia, and necrotizing enterocolitis in preterm infants 3, 4, 5, 6
• Many infants have physiologic GER that is self-limiting and improves with age, and PPIs are not superior to placebo for reducing irritability in infants 3, 4