Antireflux surgery in infants with bronchopulmonary dysplasia.

We reviewed the medical records of nine infants with severe bronchopulmonary dysplasia and gastroesophageal reflux who underwent fundoplication-gastrostomy surgery. All the infants were born prematurely, required preoperative mechanical ventilation, and were failing to thrive. The operative procedure was well tolerated by all the infants. Seven patients were extubated by day 11, and two patients required long-term ventilation. There were two postoperative deaths, both attributed to acute respiratory deterioration followed by cardiorespiratory failure. The postsurgical respiratory response was observed to be a rapid decrease in oxygen requirements and an absence of further aspiration episodes. A mean decrease of 0.14 in fractional inspired oxygen concentration was noted by 30 days postoperatively, and by 180 days the decrease in fractional inspired oxygen concentration was 0.22. All infants were fed by gastrostomy by postoperative day 4, with no evidence of clinical reflux. The nutritional response was noted to be an increase in growth velocity with increasing age (ie, catch-up growth) and ease of feeding. At both 30 and 180 days postoperatively, the mean growth velocity was more than double the preoperative growth velocity. In addition, ease of postoperative feeding reduced the nursing care requirements and allowed earlier discharge from hospital. Fundoplication and gastrostomy is effective in facilitating growth and feeding in addition to decreasing oxygen requirements in infants with severe bronchopulmonary dysplasia and gastroesophageal reflux.