Abstract
OBJECTIVE: To determine the relationship between respiratory patterns and acid gastro-esophageal reflux (g-e reflux) prior to discharge of the formerly preterm infant.
STUDY DESIGN: Forty-five infants of <32 weeks' gestation were studied at an average postmenstrual age of 37.2 weeks (SD 3.5). Following informed parental consent, a 12-hour multichannel recording including esophageal pH was obtained. Apneas of greater than 10 seconds were recorded, as well as the occurrence of bradycardia or desaturation.
RESULTS: Acid g-e reflux (pH <4.0) occurred at least once in all of the infants; prevalence was between <1% and 41% of the 12-hour record (median 4.6%, interquartile range 0.5% to 9%). The number of reflux episodes ranged from 1 to 143 (median 23). The number of apneas (>10 seconds duration) ranged from 0 to 71, median 6. There was no correlation between apnea frequency or severity and reflux frequency or duration. There was no difference in apnea frequencies between the 5 minutes after the start of a reflux episode and the 5 minutes prior to each episode.
CONCLUSION: Acid g-e reflux in the formerly preterm infant at discharge is frequent and may be prolonged; there is no association between reflux and apnea.
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References
Barrington KJ, Finer N, Li D . Predischarge respiratory recordings in very low birth weight newborn infants J Pediatr 1996 129: 6 934–40
Southall DP, Richards JM et al. Prolonged apnea and cardiac arrhythmias in infants discharged from neonatal intensive care units: failure to predict an increased risk for sudden infant death syndrome Pediatrics 1982 70: 844
Cheung PY, Barrington KJ, Finer NN, Robertson CM . Early childhood neurodevelopment in very low birth weight infants with predischarge apnea Pediatr Pulmonol 1999 27: 1 14–20
Marino AJ, Assing E, Carbone MT, Hiatt IM, Hegyi T, Graff M . The incidence of gastroesophageal reflux in preterm infants J Perinatol 1995 15: 5 369–71
Frakaloss G, Burke G, Sanders M . Impact of gastroesophogeal reflux on growth and hospital stay in premature infants J Pediatr Gastroenterol Nutr 1998 26: 146–50
Ferlauto JJ, Walker MW, Martin MS . Clinically significant gastroesophageal reflux in the at-risk premature neonate: relation to cognitive scores, days in the NICU, and total hospital charges J Perinatol 1998 18: 6 455–9
Ward R, Lemons J, Molteni R . Cisapride: a survey of the frequency of use and adverse events in premature newborns Pediatrics 1999 103: 469–72
de Ajuriaguerra M, Radvanyi-Bouvet MF, Huon C, Moriette G . Gastroesophageal reflux and apnea in prematurely born infants during wakefulness and sleep Am J Dis Child 1991 145: 10 1132–6
Suys B, De Wolf D, Hauser B, Blecker U, Vandenplas Y . Bradycardia and gastroesophageal reflux in term and preterm infants: is there any relation? JPediatr Gastroenterol Nutr 1994 19: 2 187–90
Orenstein S . Infantile reflux: different from adult reflux Am J Med 1997 103: 114S–9S
Taminiau JA . Gastro-oesophageal reflux in children Scand J Gastroenterol Suppl 1997 223: 18–20
Skopnik H, Silny J, Heiber O et al. Gastroesophageal reflux in infants: evaluation of a new intraluminal impedance technique J Pediatr Gastroenterol Nutr 1996 23: 5 591–8
Menon AP, Schefft GL, Thach BT . Apnea associated with regurgitation in infants J Pediatr 1985 106: 4 625–9
Cohen R, O'Laughlin E, Davidson G, Moore D, Lawrence D . Cisapride in the control of symptoms in infants with gastroesophageal reflux: a randomized, double-blind, placebo-controlled trial J Pediatr 1999 134: 287–92
Scott RB, Ferreira C, Smith L et al. Cisapride in pediatric gastroesophageal reflux J Pediatr Gastroenterol Nutr 1997 25: 5 499–506
Schulman R . Cisapride doesn't work? Don't go breakin' my heart! J Pediatr 1999 134: 262–4
McClure RJ, Kristensen JH, Grauaug A . Randomised controlled trial of cisapride in preterm infants Arch Dis Child Fetal Neonatal Ed 1999 80: 3 F174–7
Ng SC, Quak SH . Gastroesophageal reflux in preterm infants: norms for extended distal esophageal pH monitoring J Pediatr Gastroenterol Nutr 1998 27: 4 411–4
Stark AR, Carlo WA, Tyson JE et al. Adverse effects of early dexamethasone treatment in extremely-low-birth-weight infants N Engl J Med 2001 344: 2 95–101
Leach R, Robertson T, Twort C, Ward J . Hypoxic vasoconstriction in rat pulmonary and mesenteric arteries Lung Cell Mol Physiol 1994 10: L223–31
Kentrup H, Baisch HJ, Kusenbach G, Heimann G, Skopnik H . Effect of cisapride on acid gastro-oesophageal reflux during treatment with caffeine Biol Neonate 2000 77: 2 92–5
Tan K, Barrington KJ, Finer NN . Predischarge respiratory recordings in premature infants; influence of gestational age, postconceptional age, bpd, and intubation on apnea frequency and type Pediatr Res 1998 43: 299 (Abstract)
Martin R, Fanaroff A . Neonatal apnea, bradycardia, or desaturation: does it matter? J Pediatr 1998 132: 5 1–3
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Barrington, K., Tan, K. & Rich, W. Apnea at Discharge and Gastro-Esophageal Reflux in the Preterm Infant. J Perinatol 22, 8–11 (2002). https://doi.org/10.1038/sj.jp.7210609
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DOI: https://doi.org/10.1038/sj.jp.7210609
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