Coordinatore:
Flavia Indrio
f.indrio@neonatologia.uniba.it

Dati in corso di pubblicazione.

GASTROINTESTINAL PROBLEM IN THE NEONATAL INTENSIVE CARE UNIT: RESULTS OF AN ITALIAN SURVEY. WORKING GROUP OF NEONATAL GASTROENTEROLOGY OF THE ITALIAN SOCIETY OF PEDIATRIC GASTROENTEROLOGY AND NUTRITION (SIGENP)

The management of gastrointestinal diseases in term and preterm infant represent a problem in term of diagnosis and therapy. We describe current NICU practices with respect to diagnostic and therapeutics procedures and frame the most common gastrointestinal problem in the NICU. Between October 2004 and January 2005 a questionnaire was sent to the Italian NICU.( III level Neonatology Department.) Of 110 telephone survey we receive 66 answers (60%) who include 86737 newborns and 16367 preterm. The answers were focused on these last neonates. The estimate incidence of GER was 3%. The major symptoms because a neonate was investigated were: apnoea resistant to the conventional treatment. (100%), regurgitation and difficult to feed ( 40%) each . GER was diagnosed on ultrasound and clinical examination in 48% of the units, 22% used clinical examination alone. Intraesophageal pH monitoring was used in 12 % of the newborns ,other investigations were used in 3%. Common treatment strategies were oral H2 antagonist (100 %), proton pump inhibitor (3%) and antiacids (3%) , procinetic drugs were used in 2% of the NICU. None of the newborns received as treatment feed thickeners. The reported incidence of NEC was 0.53 % (calculated on the total number of preterm). Oesophageal atresia and intestinal atresia rates were 10,5 per 10000 live births and 8.3 per 10000 live births respectively. The hydrolyzed formula was used only for dismotility problem (37%) and for the enteral feeding after a surgical intervention on the intestine (22%).In the 35 % of NICU hydrolyzed formula was never used. CONCLUSION: This national survey showed that the management of gastrointestinal problem is significantly different in the NICU. No “gold” standard exists nationally and there is considerable variation in diagnostic and therapeutical practice. The incidence of GER is underestimated(1), the incidence of NEC, oesophageal and intestinal atresia is similar at the other data reported in literature. This wide variation in diagnostic and treatment strategies shows the need of randomized clinical trials to evaluate standardized strategies.