Gastroesophageal reflux disease (GORD) provides a diagnostic and therapeutic challenge to many Neonatologists. Reflux of gastric contents is common in preterm infants but usually not pathological. GORD is frequently diagnosed despite the lack of a fully identified clinical syndrome and of a truly valid diagnostic test. Treatment modalities, for which there is little convincing evidence regarding efficacy, are commonly instigated for troublesome symptoms attributed to GORD. Diagnosis is so problematic in preterm infants that GORD is starting to be described as the clinical syndrome that responds to anti-reflux therapy. We discuss the dilemmas facing us when dealing with this condition, summarise the best available evidence regarding diagnosis and management and use it to inform a suggested treatment pathway. We introduce the concept of a clinical scoring system to aid the diagnosis and monitoring of GORD in preterm infants and highlight areas where further research would be beneficial.
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