In a series of symptomatic and asymptomatic preterm infants who had reached 32 to 34 weeks postconceptual age, reflux scintigraphy demonstrated a high incidence of reflux in both groups that did not correlate with symptoms [40]. Use of this examination thus may be limited to patients older than 3 months of age in which other modalities have excluded an anatomic cause for feeding disorders [35,41,42]. US Abdomen (UGI Tract) There is no relevant literature to support the use of US in the diagnosis of reflux, and inconsistent results are reported with sensitivity ranging from 38% to 100% [43-47]. US diagnosis of reflux is made by visualizing water placed into the stomach refluxing into the distal esophagus. However, there is no standardization of the study, and the amount of water and duration of observation varies. Variant 7: Infant older than 2 weeks and up to 3 months old. New onset nonbilious vomiting (suspected hypertrophic pyloric stenosis). Initial imaging. Fluoroscopy Contrast Enema There is no relevant literature to support the use of contrast enema for evaluation of HPS. Fluoroscopy Upper GI Series Though the UGI series is excellent for diagnosing obstructive causes of vomiting in this age group, it is less ideal than US as an initial imaging test if HPS is a strong consideration [48,49]. Nuclear Medicine Gastroesophageal Reflux Scan If all other causes of vomiting have been excluded, reflux scintigraphy using Tc-99m sulfur colloid may be useful for functional evaluation of gastric emptying, although such patients are typically older than 3 months of age when scintigraphy is requested. Vomiting in Infants Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation. For additional information on the Appropriateness Criteria methodology and other supporting documents go to www. acr.org/ac.
Vomiting in Infants. In a series of symptomatic and asymptomatic preterm infants who had reached 32 to 34 weeks postconceptual age, reflux scintigraphy demonstrated a high incidence of reflux in both groups that did not correlate with symptoms [40]. Use of this examination thus may be limited to patients older than 3 months of age in which other modalities have excluded an anatomic cause for feeding disorders [35,41,42]. US Abdomen (UGI Tract) There is no relevant literature to support the use of US in the diagnosis of reflux, and inconsistent results are reported with sensitivity ranging from 38% to 100% [43-47]. US diagnosis of reflux is made by visualizing water placed into the stomach refluxing into the distal esophagus. However, there is no standardization of the study, and the amount of water and duration of observation varies. Variant 7: Infant older than 2 weeks and up to 3 months old. New onset nonbilious vomiting (suspected hypertrophic pyloric stenosis). Initial imaging. Fluoroscopy Contrast Enema There is no relevant literature to support the use of contrast enema for evaluation of HPS. Fluoroscopy Upper GI Series Though the UGI series is excellent for diagnosing obstructive causes of vomiting in this age group, it is less ideal than US as an initial imaging test if HPS is a strong consideration [48,49]. Nuclear Medicine Gastroesophageal Reflux Scan If all other causes of vomiting have been excluded, reflux scintigraphy using Tc-99m sulfur colloid may be useful for functional evaluation of gastric emptying, although such patients are typically older than 3 months of age when scintigraphy is requested. Vomiting in Infants Supporting Documents The evidence table, literature search, and appendix for this topic are available at https://acsearch. acr.org/list. The appendix includes the strength of evidence assessment and the final rating round tabulations for each recommendation. For additional information on the Appropriateness Criteria methodology and other supporting documents go to www. acr.org/ac.