OBJECTIVE: Gastroesophageal reflux disease (GERD) is defined as bothersome symptoms related to involuntary retrograde propulsion of gastric contents to esophagus. In prematurity, esophagus peristaltic weakness due to lack of receptive relaxation contribute to inadequate cleaning of material reflux to esophagus which become GERD predisposition. Furthermore, GERD can cause a decline of quality of life and various complications such as failure to thrive, chronic respiratory disorder, esophagitis, and esophageal stricture if pediatrician could not detect earlier. This report aims to describe severe GERD case in a marasmus child born
prematurely.
CASE: A 14-month-old girl hospitalized in Dr. Cipto Mangunkusumo General Hospital suffered from persistent vomitus. She was prematurely born at 31 weeks of gestation with birthweight of 900 gram, and become severely malnourished, developmental delayed, and was diagnosed GERD. The gastrointestinal endoscopic procedure revealed a severe esophagitis, erosive gastritis, pyloric stricture, and laryngopharyngeal reflux (LPR). She was put on proton pump inhibitors (PPI) and underwent one time pyloric dilatation with nasogastric-jejunal feeding tube (NJFT) insertion for maintained optimal nutrition, before gradually switched to normal food. In 12 months follow-ups, she exhibited an increase in weight-for-length Z score <-3 SD to -2<Z score <-1 SD, length-for-age <-3SD to - 3<Z score< -2 SD and head circumference -3SD to -3<Z score<-2 SD. Over all, her development improved, however, not yet catch up the normal milestone of her age.
CONCLUSION: In dealing with premature baby, we should consider GERD as one of growth faltering etiologies. Besides overcome the GERD, endoscopy procedure followed by NJFT insertion for long-term nutrition therapy in severe GERD are the cornerstones to reduce complications and to improve quality of life. Furthermore, close follow up for optimal growth and development should be done in such case.