Regurgitation

Regurgitation of small amounts is common in neonates due to reduced lower esophageal sphincter pressure and relatively increased intragastric pressure. Parents may confuse regurgitation with vomiting. Vomiting results from forceful contraction of the diaphragm and abdominal muscles, whereas regurgitation is independent of any effort and probably represents the ultimate degree of gastrointestinal reflux. If the neonate is thriving, parents can be reassured that regurgitation is of no clinical significance and will decrease as the infant grows. Infants who are not thriving or having respiratory symptoms should be investigated for anatomic causes of regurgitation or chronic aspiration.

Regurgitation rarely results from pathologic processes, such as intrinsic compression of the esophagus or occasionally compression of the trachea, in which case it is usually accompanied by stridor and cough. Dysphagia, irritability, anemia due to chronic blood loss, and malnutrition are sequelae of chronic regurgitation with esophagitis, but this condition is rare. Investigations such as scintigraphy, pH monitoring, endoscopy, and biopsy are utilized to confirm the diagnosis of reflux esophagitis. These invasive tests are not justified in patients who are healthy and are not done on an emergency basis. Such infants usually respond well to thickening of feedings. The infant's upper body can be elevated after feedings added if thickening of feedings alone does not resolve the regurgitation. -I7

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