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

被引:18
作者
Dahlen, Hannah Grace [1 ,2 ]
Foster, Jann P. [1 ,2 ,3 ]
Psaila, Kim [1 ]
Spence, Kaye [4 ]
Badawi, Nadia [4 ,5 ]
Fowler, Cathrine [6 ]
Schmied, Virginia [1 ]
Thornton, Charlene [1 ]
机构
[1] Western Univ Sydney, Sch Nursing & Midwifery, Locked Bag 1797, Penrith, NSW 2751, Australia
[2] Ingham Inst, Liverpool, NSW, Australia
[3] Univ Sydney, Discipline Obstet Gynaecol & Neonatol, Ctrl Clin Sch, Sydney, NSW, Australia
[4] Childrens Hosp Westmead, Grace Ctr Newborn Care, Cnr Hawkesbury Rd & Hainsworth St, Westmead, NSW 2145, Australia
[5] Univ Sydney, Sydney Med Sch, Sydney, NSW, Australia
[6] Univ Technol, Tresillian Chair Child & Family Hlth, Sydney, NSW 2007, Australia
基金
澳大利亚研究理事会;
关键词
gastro-oesophageal reflux; GOR; GORD; mental health; caesarean section; diagnosis; CESAREAN-SECTION; MENTAL-HEALTH; TERM INFANTS; PRETERM; REGURGITATION; SYMPTOMS; RISK; MECHANISMS; CHILDREN; MOTHERS;
D O I
10.1186/s12887-018-0999-9
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
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 12 months 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 12 months 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-38 weeks); 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).
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页数:15
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