Elrefaee A, Abdel-Razek ARA, Abdelkhalek ZS, Samaan P, Kamal AF. Incidence of gastro-esophageal reflux disease in mechanically ventilated full-term Egyptian neonates by detection of pepsin in endotracheal aspirate. World J Clin Pediatr 2025; 14(3): 102309 [DOI: 10.5409/wjcp.v14.i3.102309]
Corresponding Author of This Article
Amir Fawzy Kamal, MD, Department of Pediatrics, Faculty of Medicine, Cairo University, Kasr Al-Aini Street, Cairo 11562, Al Qāhirah, Egypt. amirfawzy12314@gmail.com
Research Domain of This Article
Pediatrics
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Pediatr. Sep 9, 2025; 14(3): 102309 Published online Sep 9, 2025. doi: 10.5409/wjcp.v14.i3.102309
Incidence of gastro-esophageal reflux disease in mechanically ventilated full-term Egyptian neonates by detection of pepsin in endotracheal aspirate
Amira Elrefaee, Abdel-Rahman A Abdel-Razek, Zeinab S Abdelkhalek, Peter Samaan, Amir Fawzy Kamal
Amira Elrefaee, Abdel-Rahman A Abdel-Razek, Peter Samaan, Amir Fawzy Kamal, Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo 11562, Al Qāhirah, Egypt
Zeinab S Abdelkhalek, Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo 11562, Egypt
Author contributions: Elrefaee A, Abdel-Razek ARA, Samaan P, Abdelkhalek ZS, and Kamal AF were actively involved in data collection, patient management, and analysis of study findings. All authors contributed to the writing and revision of the manuscript, ensuring clarity and coherence. Each author critically reviewed and approved the final version of the manuscript, affirming the accuracy and integrity of the research.
Institutional review board statement: This study was conducted in accordance with the principles outlined in the Declaration of Helsinki and approved by the Research Ethics Committee of the Faculty of Medicine, Cairo University (No: MD-430-2022).
Informed consent statement: Written informed consent was obtained from the parents or legal guardians of all participating neonates before enrollment in the study. The consent process was conducted in accordance with the ethical guidelines of the Declaration of Helsinki, and the study was approved by the Research Ethics Committee of the Faculty of Medicine, Cairo University (No: MD-430-2022).
Conflict-of-interest statement: The authors declare no conflicts of interest related to this study.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author, Amir Fawzy Kamal, upon reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Amir Fawzy Kamal, MD, Department of Pediatrics, Faculty of Medicine, Cairo University, Kasr Al-Aini Street, Cairo 11562, Al Qāhirah, Egypt. amirfawzy12314@gmail.com
Received: October 14, 2024 Revised: March 7, 2025 Accepted: March 27, 2025 Published online: September 9, 2025 Processing time: 244 Days and 23.4 Hours
Abstract
BACKGROUND
Gastroesophageal reflux disease (GERD) is common among neonates, particularly those requiring mechanical ventilation. Pepsin, a reliable marker of gastric aspiration, may help detect GER episodes in ventilated neonates and assess associated clinical outcomes.
AIM
To determine the incidence of GERD, associated risk factors, and morbidities among full-term mechanically ventilated neonates by detecting pepsin in endotracheal aspirates (ETA).
METHODS
This study included 97 full-term neonates admitted to the neonatal intensive care unit at Cairo University Hospitals from April 2023 to March 2024. ETA samples were collected at three intervals: Immediately post-intubation (Sample A), 48 hours after intubation (Sample B), and just before extubation (Sample C). Pepsin concentration was measured using enzyme-linked immunosorbent assay. Clinical data, including hospital stay duration and feeding parameters, were correlated with pepsin levels.
RESULTS
Pepsin was detected in 76 (78.4%) of Sample A, 78 (81.3%) of Sample B, and 47 (68.1%) of Sample C. A significant positive correlation was found between pepsin levels and FiO2 in Sample B (r = 0.203, P = 0.047). Prolonged hospital stay was also associated with pepsin detection in Samples B and C (P < 0.05). A negative correlation was observed between feeding amount and pepsin levels across all samples (P < 0.05).
CONCLUSION
The incidence of GERD in full-term mechanically ventilated neonates is high, correlating with pepsin levels, FiO2, feeding intolerance, and hospital stay, highlighting the importance of early detection.
Core Tip: This study evaluates the incidence of gastroesophageal reflux disease (GERD) in mechanically ventilated full-term neonates using pepsin detection in endotracheal aspirates (ETA). Conducted on 97 neonates, the study demonstrates that pepsin was detected in 76.7% of samples collected, with significant correlations between pepsin levels, FiO2, feeding amount, and hospital stay duration. The findings highlight the association of GER episodes with feeding intolerance and prolonged hospitalization, emphasizing the importance of early GER detection through ETA pepsin measurement. These insights can guide clinical interventions to mitigate complications and improve neonatal outcomes, though further studies are warranted to explore preventive strategies and optimize care in this vulnerable population.
