Antireflux surgery in infants with bronchopulmonary dysplasia
R. M. Giuffre, S. Rubin and I. Mitchell
We reviewed the medical records of nine infants with severe
bronchopulmonary dysplasia and gastroesophageal reflux who underwent
fundoplication-gastrostomy surgery. All the infants were born prematurely,
required preoperative mechanical ventilation, and were failing to thrive.
The operative procedure was well tolerated by all the infants. Seven
patients were extubated by day 11, and two patients required long-term
ventilation. There were two postoperative deaths, both attributed to acute
respiratory deterioration followed by cardiorespiratory failure. The
postsurgical respiratory response was observed to be a rapid decrease in
oxygen requirements and an absence of further aspiration episodes. A mean
decrease of 0.14 in fractional inspired oxygen concentration was noted by
30 days postoperatively, and by 180 days the decrease in fractional
inspired oxygen concentration was 0.22. All infants were fed by gastrostomy
by postoperative day 4, with no evidence of clinical reflux. The
nutritional response was noted to be an increase in growth velocity with
increasing age (ie, catch-up growth) and ease of feeding. At both 30 and
180 days postoperatively, the mean growth velocity was more than double the
preoperative growth velocity. In addition, ease of postoperative feeding
reduced the nursing care requirements and allowed earlier discharge from
hospital. Fundoplication and gastrostomy is effective in facilitating
growth and feeding in addition to decreasing oxygen requirements in infants
with severe bronchopulmonary dysplasia and gastroesophageal reflux.
