(11) Comparing reflux-related knowledge and beliefs in a neonatal intensive care unit

Background: Gastroesophageal reflux (GER) is an asymptomatic physiologic backflow of gastric contents into the esophagus and commonly occurs in neonates. When this process becomes symptomatic, it is known as gastroesophageal reflux disease (GERD). The diagnosis of GERD is not benign; hospitalized infants with GERD have longer hospital stays and treatment can cause complications. However, distinguishing GER from GERD is difficult given nonspecific symptoms. As a result, there is large variability in diagnosis and clinical management of GERD among clinicians in neonatal intensive care units (NICUs).

Objectives: The aim was to compare knowledge gaps and beliefs for GER and GERD among NICU bedside nurses and providers (attendings, fellows, nurse practitioners, residents).

Design/Methods: An anonymous online survey assessing knowledge and beliefs regarding GER and GERD was distributed to NICU bedside nurses and providers in an standalone tertiary NICU (Table 1). The Mann-Whitney U Test compared data between two groups: bedside nurses and providers. The 5 point Likert scale was used for questions 5-13, with agreement associated with non-evidence based beliefs.

Results: A total of 87 participants completed the survey, comprising 41.7% (n=41) bedside nurses and 52.9% (n=46) providers. There were multiple group differences related to knowledge and perceptions among bedside nurses and providers (Table 2). Among survey respondents, bedside nurses had more experience working exclusively in the NICU (p=0.002). Bedside nurses were more likely than providers to believe that there was a higher prevalence of GERD (p=0.001), treatment of GERD improves apnea/bradycardia/desaturation events (p < 0.001), utility of fluoroscopic swallowing studies to diagnose GERD (p=0.001), and benefits of acid blocking medications and erythromycin. Providers were more likely to believe that head of bed elevation is useful for treatment of GER and GERD (p=0.03).

Conclusion: Knowledge gaps regarding GER and GERD were prevalent among NICU bedside nurses and providers surveyed. Despite more experience working the NICU, bedside nurses were less likely than providers to hold evidence-based beliefs among the questions asked. These deficiencies in knowledge demonstrate the need for standardization of GERD treatment and create ample opportunity for improvement in patient care via implementation of a reflux clinical pathway.