Incidence of gastro-esophageal reflux disease in mechanically ventilated full-term Egyptian neonates by detection of pepsin in endotracheal aspirate

Table 1 Baseline characteristics and characteristics of the examined cases, n (%)/mean ± SD/median (IQR)

Characteristics	Total (n = 97)
Age on intubation (days)
Median (IQR)	1 (1–2)
Range	1–10
Intubation since birth
		Yes
65 (67.0)
No	32 (33.0)
Sex
Male	66 (68.0)
Female	31 (32.0)
Birth weight (kg)
		mean ± SD
2.84 ± 0.45
Range	1.89–4.5
Weight for age
		Appropriate for GA (2.5 kg or more)
76 (78.4)
Small for GA (less than 2.5 kg)	21 (21.6)
Mode of delivery
Cesarean section	83 (85.6)
Normal vaginal delivery	14 (14.4)
APGAR score at 1 minute
Median (IQR)	3 (1–3)
Range	0-7
APGAR score at 5 minutes
Median (IQR)	7 (6–8)
Range	2–10
Resuscitation
Positive pressure ventilation	35 (36.1)
Tactile stimulation	12 (12.4)
Intubation	50 (51.5)

IQR: Interquartile range; Kg: Kilograms; GA: Gestational age; APGAR: Appearance, Pulse, Grimace, Activity, Respiration.

Table 2 Pepsin in sample A, B, and C of the studied cases, n (%)

Characteristics	Total (n = 97)
Sample A ETA pepsin (ng/mL)
Median (IQR)	0.87 (0.11–2.58)
Range	0.01–31
Pepsin detection in sample A
Not detected	21 (21.6)
Detected	76 (78.4)
Sample B ETA pepsin (ng/mL)
Median (IQR)	0.84 (0.23–2.68)
Range	0.01–12.5
Pepsin detection in sample B
Not detected	18 (18.8)
Detected	78 (81.3)
Sample C ETA pepsin (ng/mL)
Median (IQR)	0.43 (0.05–1.63)
Range	0.01–8.68
Pepsin detection in sample C
Not detected	22 (31.9)
Detected	47 (68.1)

ETA: Endotracheal aspirate; IQR: Interquartile range.

Table 3 Relation of pepsin detection in sample A, B, and C with endotracheal aspirate culture of the studied cases, n (%)

		Pepsin detection in sample A		Test value	P value
		No detection (n = 21)	Detected (n = 76)
ETA culture	Not done	5 (23.8)	8 (10.5)	4.0961	0.129
	No growth	10 (47.6)	30 (39.5)
	Positive	6 (28.6)	38 (50)
Pepsin detection in sample B
ETA culture	Not done	2 (11.1)	11 (14.1)	1.0391	0.595
	No growth	6 (33.3)	34 (43.6)
	Positive	10 (55.6)	33 (42.3)
Pepsin detection in sample C
ETA culture	Not done	3 (13.6)	4 (8.5)	0.506	0.776
	No growth	9 (40.9)	22 (46.8)
	Positive	10 (45.5)	21 (44.7)

¹χ² test, lower limit of pepsin detection is 0.0625 ng/mL.

ETA: Endotracheal aspirate.

Table 4 Duration of hospital stay and outcome of the studied cases, n (%)

Characteristics	Total (n = 97)
Duration of hospital stay (days)
Median (IQR)	15 (10–22)
Range	4–35
Outcome
Died	38 (39.2)
Discharged	59 (60.8)

IQR: Interquartile range.

Table 5 Relation of pepsin detection in sample B with pepsin levels and pepsin detection in sample A and sample C of the studied cases, n (%)

	Pepsin detection in sample B		Test value	P value
	No detection (n = 18)	Detected (n = 78)
Sample A ETA pepsin (ng/mL)			-1.314	0.189
					Median (IQR)
0.48 (0.02–1.9)	0.94 (0.28–2.67)
Range	0.01–7.27	0.01–31
Pepsin detection in sample A			3.752	0.053
					No detection
7 (38.9)	14 (17.9)
Detected	11 (61.1)	64 (82.1)
Sample C ETA pepsin (ng/mL)			-1.794	0.073
					Median (IQR)
0.03 (0.01–1.43)	0.51 (0.06–1.73)
Range	0.01–4.02	0.01–8.68
Pepsin detection in sample C			4.494	0.034a
					No detection
7 (58.3)	15 (26.8)
Detected	5 (41.7)	41 (73.2)

^aP < 0.05.

ETA: Endotracheal aspirate; IQR: Interquartile range.

Table 6 Correlation of pepsin in sample A, B and C with other studied parameters among the studied cases

	Sample A ETA pepsin (ng/mL)		Sample B ETA pepsin (ng/mL)		Sample C ETA pepsin (ng/mL)
	r	P value	r	P value	r	P value
Age on intubation (days)	-0.027	0.791	0.082	0.429	-0.170	0.164
Birth weight	0.010	0.919	0.155	0.132	-0.137	0.261
APGAR score at 1 minute	-0.082	0.426	0.027	0.795	0.008	0.951
APGAR score at 5 minutes	-0.020	0.847	-0.062	0.549	0.087	0.476
Proton pump inhibitor (days)	-0.004	0.981	0.054	0.748	-0.049	0.816
Prokinetic drugs (days)	0.005	0.976	-0.050	0.784	-0.230	0.259
Duration of MV (days)	0.080	0.438	0.130	0.208	-0.129	0.292
FiO2	0.166	0.104	0.203	0.047a	0.193	0.112
Amount of feeding (mL/day)	-0.210	0.039a	-0.234	0.022a	-0.267	0.027a
Duration of hospital stay (days)	0.031	0.766	0.288	0.004a	0.559	0.000a

^aP < 0.05.

Sample A was withdrawn immediately after intubation, Sample B was withdrawn 48 hours after intubation, Sample C was withdrawn immediately before extubation. ETA: Endotracheal aspirate; r: Pearson correlation coefficient; MV: Mechanical ventilation; APGAR: Appearance, Pulse, Grimace, Activity, Respiration.