Gastro-oesophageal reflux: A mixed methods study of infants admitted to hospital in the first 12months following birth in NSW (2000-2011).

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Dahlen, H., Foster, J., Psaila, K, Spence, K, Badawi, N, Fowler, C, Schmied, V and Thornton, C, 2018. Gastro-oesophageal reflux: A mixed methods study of infants admitted to hospital in the first 12months following birth in NSW (2000-2011). BMC Pediatrics, 18 (1).

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DOI: 10.1186/s12887-018-0999-9

Abstract

Background: Gastro-oesophageal reflux (GOR) is common in infants. When the condition causes pathological symptoms and/or complications it is considered gastro-oesophageal reflux disease (GORD). It appears to be increasingly diagnosed and causes great distress in the first year of infancy. In New South Wales (NSW), residential parenting services support families with early parenting difficulties. These services report a large number of babies admitted with a label of GOR/GORD. The aim of this study was to explore the maternal and infant characteristics, obstetric interventions, and reasons for clinical reporting of GOR/GORD in NSW in the first 12months following birth (2000-2011). Methods: A three phase, mixed method sequential design was used. Phase 1 included a linked data population based study (n=869,188 admitted babies). Phase 2 included a random audit of 326 medical records from admissions to residential parenting centres in NSW (2013). Phase 3 included eight focus groups undertaken with 45 nurses and doctors working in residential parenting centres in NSW. Results: There were a total of 1,156,020 admissions recorded of babies in the first year following birth, with 11,513 containing a diagnostic code for GOR/GORD (1% of infants admitted to hospitals in the first 12months following birth). Babies with GOR/GORD were also more likely to be admitted with other disorders such as feeding difficulties, sleep problems, and excessive crying. The mothers of babies admitted with a diagnostic code of GOR/GORD were more likely to be primiparous, Australian born, give birth in a private hospital and have: a psychiatric condition; a preterm or early term infant (37-or-38weeks); a caesarean section; an admission of the baby to SCN/NICU; and a male infant. Thirty six percent of infants admitted to residential parenting centres in NSW had been given a diagnosis of GOR/GORD. Focus group data revealed two themes: "It is over diagnosed" and "A medical label is a quick fix, but what else could be going on?" Conclusions: Mothers with a mental health disorder are nearly five times as likely to have a baby admitted with GOR/GORD in the first year after birth. We propose a new way of approaching the GOR/GORD issue that considers the impact of early birth (immaturity), disturbance of the microbiome (caesarean section) and mental health (maternal anxiety in particular). © 2018 The Author(s).

Item Type:	Article
ISSN:	1471-2431
Additional Information:	Cited By :18 Export Date: 7 September 2022 CODEN: BPMEB Correspondence Address: Dahlen, H.G.; Western Sydney University, Locked Bag 1797, Australia; email: h.dahlen@westernsydney.edu.au Funding text 1: The authors would like to acknowledge the funding provided by the above listed institutions and the assistance provided by the staff at Tresillian and Karitane. This study is part of an Australian Research Linkage Grant. Funding text 2: This study is part of a larger study funded by the Australian Research Council to examine the physical, psychological and demographic characteristics, trends, service needs and co-admissions to other health services of women admitted to residential parenting services (RPS) of Tresillian and Karitane in NSW from 2000 to 2011. There is a tiered system of health services in Australia providing maternal and child health support, including, non-psychiatric day stay and residential parenting services (RPS) such as Tresillian and Karitane (in NSW). Funding text 3: Funding was provided by an Australian Research Council Partnership grant between Western Sydney University, Tresillian and Karitane. 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(2013) Arch Womens Mental Health, 16, pp. 391-399; McMahon, C., Barnett, B., Kowalenko, N., Tennant, C., Don, N., Postnatal depression, anxiety and unsettled infant behaviour (2001) Aust N Z J Psychiatry, 35, pp. 581-588; Radesky, J.S., Zuckerman, B., Siverstein, M., Rivara, F.P., Barr, M., Taylor, J.A., Lengua, L.J., Barr, R.G., Inconsolable infant crying and maternal postpartum epressive symptoms (2013) Pediatrics, 131 (6), pp. e1857-e1864; Petzoldt, J., Wittchen, H.U., Einsle, F., Martini, J., Maternal anxiety versus depressive disorders: specific relations to infants' crying, feeding and sleeping problems (2015) Child Care Health Dev; Petzoldt, J., Maternal anxiety disorders predict excessive infant crying: a prospective longitudinal study (2014) Arch Dis Child, 99, pp. 800-806; Postert, C., Averbeck-Holocher, M., Arhtergarde, S., Muller, J.M., Furniss, T., Regulatory disorders in early childhood: correlates in child behavior, parent-child relationship, and parental mental health (2013) Infant Mental Health Journal, 33, pp. 173-186; Bolten, M., Infant psychiatric disorders (2013) Eur Child Adolesc Psychiatry, 22, pp. S69-S74; Karacetin, G., Demir, T., Erkan, T., Cokugras, F.C., Sonmez, A.B., Maternal psychopathology and psychomotor development of children with GERD (2011) JPGN, 53 (4), pp. 380-385; Vaiserman, A.M., The developmental origins of health and disease hypothesis which suggests early environmental factors influence mental and physical health into adulthood has been described (2015) Dev Dyn, 244, pp. 254-265; Schmid, G., Wolke, D., Preschool regulatory problems and attention-deficit/hyperactivity and cognitive deficits at school age in children born at risk: different phenotypes of dysregulation? (2014) Early Hum Dev, 90, pp. 399-405; Hegar, B., Dewanti, N.R., Kadim, M., Alatas, S., Firmansyah, A., Vandenplas, Y., Natural evolution of regurgitation in healthy infants (2009) Acta Paediatr, 98 (7), pp. 1189-1193; Fike, F., Mortellaro, V.E., Pettiford, M.P., Ostlie, D.J., Diagnosis of gastroesophageal reflux disease in infants (2011) Pediatr Surg Int, 27, pp. 791-797; Lightdale, J.R., Gremse, D.A., Gastroesophageal reflux: management guidance for the pediatrician (2013) Pediatrics, 131 (5), pp. e1684-e1895; Quitadamo, P., Papadopoulou, A., Wenzl, T., Urbonas, V., Kneepkens, C.M.F., Roman, E., Orel, R., Vandenplas, Y., European pediatricians' approach to children with GER symptoms: survey of the implementation of 2009 NASPGHAN-ESPGHAN guidelines (2014) J Pediatr Gastroenterol Nutr, 58 (4), pp. 505-509; Bialek-Gieruszczak, D., Konarska, Z., Skorka, A., No effect of proton pump inhibitors on crying and irritability in infants: systematic review of randomized controlled trials (2015) J Pediatr, 166, pp. 767-770; Orenstein, S.R., Hassall, E., Furmaga-Jablonska, W., Atkinson, S., Raanan, M., Multi-centre, double-blind randomized placebo-controlled trial assessing the efficacy of proton pump inhibitor lansoprazole in infants with symptoms of gastroesophageal reflux disease (2009) J Pediatr, 154, pp. 514-520; van der Pol, R., Smits, M.J., Venmans, L., Boluyt, N., Benninga, M.A., Tabbers, M.M., Diagnostic accuracy of tests in pediatric gastroesophageal reflux disease (2013) J Pediatr, 162 (5), pp. 983-987; Verhage, M.L., Oosterman, M., Schuengel, C., The linkage between infant negative temperament and parenting self-efficacy: the role of resilience against negative performance feedback (2015) Br J Dev Psychol, 33, pp. 506-518; Lightdale, J.R., Gremse, D.A., Section on gastroenterology, hepatology and nutrition. Gastroesophageal relux: management guidance for the pediatrician (2013) Pediatrics, 131, pp. e1684-e1695; Verhage, M.L., Oosterman, M., Schuengel, C., The linkage between infant negative temperament and parenting self-efficacy: The role of resilience against negative performance feedback (2015) British J Dev Psychol, 33, p. 506; Meijer, A.M., van den Wittenboer, G.L.H., Contribution of infants' sleep and crying to marital relationships of first-time parent couples in the 1st year after childbirth (2007) J Fam Psychol, 21, pp. 49-57; Jordan, B., Heine, R.G., Meehan, M., Catto-Smith, A.G., Lubitz, L., Effect of antireflux medication, placebo and infant mental health intervention on persistent crying: a randomized clinical trial (2006) J Paediatr Child Health, 42, pp. 49-58; Petzoldt, J., Wittchen, H.U., Einsle, F., Martini, J., Maternal anxiety versus depressive disorders: specific relations to infants' äô crying, feeding and sleeping problems (2015) Child Care Health Dev Background: Gastro-oesophageal reflux (GOR) is common in infants. When the condition causes pathological symptoms and/or complications it is considered gastro-oesophageal reflux disease (GORD). It appears to be increasingly diagnosed and causes great distress in the first year of infancy. In New South Wales (NSW), residential parenting services support families with early parenting difficulties. These services report a large number of babies admitted with a label of GOR/GORD. The aim of this study was to explore the maternal and infant characteristics, obstetric interventions, and reasons for clinical reporting of GOR/GORD in NSW in the first 12months following birth (2000-2011). Methods: A three phase, mixed method sequential design was used. Phase 1 included a linked data population based study (n=869,188 admitted babies). Phase 2 included a random audit of 326 medical records from admissions to residential parenting centres in NSW (2013). Phase 3 included eight focus groups undertaken with 45 nurses and doctors working in residential parenting centres in NSW. Results: There were a total of 1,156,020 admissions recorded of babies in the first year following birth, with 11,513 containing a diagnostic code for GOR/GORD (1% of infants admitted to hospitals in the first 12months following birth). Babies with GOR/GORD were also more likely to be admitted with other disorders such as feeding difficulties, sleep problems, and excessive crying. The mothers of babies admitted with a diagnostic code of GOR/GORD were more likely to be primiparous, Australian born, give birth in a private hospital and have: a psychiatric condition; a preterm or early term infant (37-or-38weeks); a caesarean section; an admission of the baby to SCN/NICU; and a male infant. Thirty six percent of infants admitted to residential parenting centres in NSW had been given a diagnosis of GOR/GORD. Focus group data revealed two themes: "It is over diagnosed" and "A medical label is a quick fix, but what else could be going on?" Conclusions: Mothers with a mental health disorder are nearly five times as likely to have a baby admitted with GOR/GORD in the first year after birth. We propose a new way of approaching the GOR/GORD issue that considers the impact of early birth (immaturity), disturbance of the microbiome (caesarean section) and mental health (maternal anxiety in particular). © 2018 The Author(s).
Uncontrolled Keywords:	Caesarean section;Diagnosis;Gastro-oesophageal reflux;GOR;GORD;Mental health;adult;anxiety;Article;cesarean section;child parent relation;clinical audit;cohort analysis;controlled study;crying;diagnostic error;feeding difficulty;female;gastroesophageal reflux;hospital admission;human;infant;major clinical study;male;New South Wales;pediatrics;primipara;sex difference;sleep disorder;gastroesophageal reflux;health service;hospitalization;information processing;maternal behavior;mental disease;microflora;newborn;pathophysiology;physiology;prematurity;psychology;Adult;Anxiety;Cesarean Section;Female;Focus Groups;Gastroesophageal Reflux;Hospitalization;Humans;Infant;Infant, Newborn;Infant, Premature;Maternal Behavior;Medical Overuse;Mental Disorders;Microbiota;New South Wales
Group:	UNSPECIFIED
ID Code:	37459
Deposited By:	Symplectic RT2
Deposited On:	07 Sep 2022 10:21
Last Modified:	07 Sep 2022 10:21

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