Maybe it’s not pHunny at all.
A good quality review article about the use of acid blockade for treating what are sometimes called ‘symptoms of reflux’. Rosen R: Gastroesophageal reflux in infants: More than just a pHenomenon. JAMA Pediatrics 2013.
Although the focus is on infants, not just neonates, the conclusions are I think identical:
1. There is no way to diagnose reflux clinically, None of the scoring systems, nor any individual symptom discriminates between infants with and without reflux.
2. Non-acid reflux is at least as frequent, and as important, or as lacking in importance, as acid reflux
3. Acid suppression worsens non-acid reflux, and is of variable efficacy in suppressing acid.
4. Acid blockade is toxic. It increases infection rates, including chest infections, adn reduces calcium absorption from the diet. A strong shift away from acid-suppression therapy in infants has occurred because of the adverse effects, lack of efficacy, and increase of nonacid reflux burden relative to acid burden.
We hopefully will have the same shift away from acid blockade in neonatology, where there is even less evidence of benefit.
The same review article refers, more briefly, to the use of pro-motility agents:
Unfortunately, all well-studied motility agents have been removed from the market because of adverse effects or carry black box warnings because the risk outweighs the benefit. Cisapride, a serotonin agonist that improved esophageal, gastric, and intestinal motility, has been removed from the market because of fatal cardiac arrhythmias. Metoclopramide hydrochloride, a receptor agonist for dopamine D2 and a serotonin 4 that improves gastric motility and may increase lower esophageal sphincter tone, has a black box warning for irreversible neurologic adverse effects, and all of the major adult and pediatric gastroenterology organizations state that the drug is not recommended because of the potential harm and lackluster efficacy.
The only thing I would change for the newborn is not ‘lackluster efficacy’ but ‘lack of efficacy’!