041 - Addressing Knowledge Gaps for Gastroesophageal Reflux Disease in a Neonatal Intensive Care Unit

Publication Number: 41.3599

Pyone David, University of Chicago Comer Children's Hospital, Chicago, IL, United States; Lauren Anderson, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Ellen Wagner, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Andrea Berkemeyer, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Brandon J. Trandai, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Tulsi Patel, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Nicki Patel, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Emiko Yamada, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Timothy Sentongo, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States; Tomas Munoz, Comer Children's Hospital at University of Chicago Medical Center, Chicago, IL, United States

Background: Gastroesophageal reflux disease is a common diagnosis among hospitalized infants in the neonatal intensive care unit (NICU). While infants commonly have asymptomatic, physiologic gastroesophageal reflux (GER), GERD is diagnosed in a small proportion of infants who become symptomatic. As GERD is a clinical diagnosis, there is large variability in both diagnosis and clinical management of GERD for NICU infants. NICU infants with a diagnosis of GERD have longer hospital stays. Additionally, GERD treatment modalities have been associated with both short- and long-term complications.

Objective: To evaluate knowledge and beliefs involving the clinical diagnosis and management of GERD at a large urban children’s hospital with the objective of implementing a clinical curriculum on GERD and examining its impact on practice patterns.

Design/Methods: A multidisciplinary educational curriculum was designed in conjunction with the pediatric gastroenterology department to educate NICU bedside nurses, attending physicians, fellows, pediatric residents, and nurse practitioners on evidence-based care of GERD. An online anonymous pre-intervention survey assessed knowledge and beliefs regarding GERD. A 5-point Likert scale was to assess clinicians’ agreement with non-evidence-based beliefs. After initial education to the care team utilizing a handout and PowerPoint presentation, an online anonymous post-intervention survey was completed.

Results: There were 88 respondents to the pre-intervention survey and 15 respondents to the post-intervention survey (Table 1). Although bedside nurses made up almost half of the pre-intervention respondents, there were no bedside nurses who responded to the post-intervention survey.

In the post-intervention period, respondents reported a smaller percentage of infants in the NICU as having GERD than the pre-intervention group (p < 0.001, Table 1). Among the post-intervention group, 15 (66.7%) reported reviewing GERD-related educational material (Figure 1).

Among questions assessing evidence-based beliefs, the post-intervention group was less likely to believe that patients with apnea/bradycardia/desaturation (A/B/D) events after feeds benefit from treatment of GERD (p=0.01, Figure 2).

Conclusion(s): A multidisciplinary educational curriculum was effective in addressing misconceptions about the prevalence and treatment indications of GERD in the NICU setting. After reviewing the curriculum, clinicians are more likely to believe in a lower prevalence of GERD in the NICU and that infants with A/B/D events after feeds do not benefit from treatment of GERD.

Table 1. Mann-Whitney U-Test Results According to Groups for Survey Questions


Figure 1. Post-intervention usage of educational material


Figure 2. Mann-Whitney U-Test Results According to Groups for Agreeability of Survey Questions


Table 1. Mann-Whitney U-Test Results According to Groups for Survey Questions


Figure 1. Post-intervention usage of educational material


Figure 2. Mann-Whitney U-Test Results According to Groups for Agreeability of Survey Questions