Can pH monitoring reliably detect gastro-oesophageal reflux in preterm infants?

Gastro-oesophageal reflux (GOR) is the regurgitation of gastric contents into the oesophagus. It is alleged to be the cause of many clinical problems in premature infants, such as failure to thrive, apnoea, desaturation, bradycardia, and stridor. 2 Twenty four hour oesophageal pH monitoring is currently regarded as the optimal method of diagnosing occult GOR in infants with respiratory events. European and North American working parties have produced guidelines for the methodology and interpretation of oesophageal pH studies in infants and children. 4 However, pH monitoring in preterm infants has shortcomings, which makes the diagnosis of GOR in this group more diYcult and its clinical significance more uncertain than in older children. This review seeks to highlight these shortcomings and to discuss the future of pH monitoring in preterm infants.