The Use of Omeprazole in Infants with Gastroesophageal Reflux-induced Wheezing

Rational approach to the wheezy infant

The infant or child presenting to the physician's office with persistent or recurrent wheezing during the first two year's of life poses a diagnostic dilemma. A careful medical history should document risk factors for persistent wheezing, including maternal smoking, feeding practices, environmental history, and family history of asthma or cystic fibrosis (CF). A suggested diagnostic approach to the causes of infantile wheezing is outlined. A chest radiograph is non-specific, but may suggest a congenital airway anomaly. Infant pulmonary function testing (IPFT) can help differentiate between central airflow (intrathoracic, extrathoracic, or fixed) and peripheral airflow obstruction. The infant with either intrathoracic, extrathoracic, or fixed airflow obstruction on the PFT may benefit from flexible fiberoptic bronchoscopy. The infant with either an intrathoracic or fixed airway obstruction should undergo an upper gastrointestinal (UGI) series to evaluate the anatomy for extrinsic tracheal compression. The response to treatment with anti-inflammatory therapy may suggest an inflammatory disease such as asthma or CF. The infant with peripheral airflow obstruction and a good response to bronchodilators (> or =25%) using the forced exhalation technique is given the diagnosis of infantile asthma. The infant with peripheral airflow obstruction and no response to bronchodilators should be evaluated further for possible gastroesophageal reflux disease (GERD), and for other causes, which are associated with wheezing symptoms.

Evaluation of the wheezy infant

BACKGROUND

The infant with persistent or recurrent wheezing during the first 2 years of life poses a diagnostic dilemma, which can be a source of anxiety to both physicians and parents. A suggested diagnostic approach to the causes of infantile wheezing is outlined.

OBJECTIVES

1. To review the physiologic considerations of the infant's airways that predispose to wheezing. 2. To discuss the key physical findings, family history, and risk factors associated with wheezing in infants. 3. To develop a rational approach to the differential diagnosis and management of infantile wheezing.

DATA SOURCES

The MEDLINE database as well as our clinical experience pertaining to infantile wheezing.

CONCLUSIONS

This review discusses the diagnostic evaluation and treatment of the wheezing infant. We suggest that infant pulmonary function testing may be used as one diagnostic aid in the workup of the wheezing infant.