Gastro-oesophageal reflux (GOR) in neonates

In June 2023, we commenced a project to review and update the Maternity and Neonatal eHandbook guidelines with a view to completion in 2024. Please be aware that pending this review, some of the current guidelines may be out of date. In the meantime, we recommend that you also refer to more contemporaneous evidence.

Gastro-oesophageal reflux (GOR) is very common in preterm infants and rarely pathological. Most infants with recurrent apnoea and bradycardia do not have GOR. Investigation and management of GOR in the neonatal unit should be reserved for those infants in whom the reflux is considered to be pathological gastro-oesophageal reflux disease (GORD).

Most infants with GOR do not require pharmacological intervention, and acid suppression may even cause harm. Feed thickener is not recommended in infants less than 35 weeks’ gestation.

Guidance

Safer Care Victoria endorses the Royal Children’s Hospital (RCH) Gastrooesophageal reflux disease in infants guidance which is endorsed by the Paediatric Improvement Collaborative.

Safer Care Victoria, Murdoch Children’s Research Institute, and RCH partnered in a project to reduce unnecessary prescribing of acid suppression therapy (AST) for infant reflux. 

Additional information can be found on the RCH Kids Health Information Fact sheet: Reflux (GOR) and GORD.