Gastroesophageal reflux increases the number of apneas in very preterm infants

Neonatology and Neonatal Intensive Care Unit, University of Bologna, Bologna, Italy.
Archives of Disease in Childhood - Fetal and Neonatal Edition (Impact Factor: 3.12). 10/2008; 94(3):F188-92. DOI: 10.1136/adc.2008.143198
Source: PubMed


To document the existence of a relationship between apnoea of prematurity (AOP) and gastro-oesophageal reflux (GER) in preterm infants.
Neonatal intensive care unit.
Twenty-six preterm infants (gestational age < or =32 weeks) with recurrent apnoeas.
Simultaneous and synchronised recording of polysomnography and pH-impedance monitoring (pH-MII). Polysomnography detects and characterises apnoeas, by recording of breathing movement, nasal airflow, electrocardiogram and pulse oximeter saturation. pH-MII is the state-of-the-art methodology for GER detection in preterm newborns.
Relationship between AOP and GER, which were considered temporally related if both started within 30 seconds of each other.
One hundred and fifty-four apnoeas out of 1136 were temporally related to GER. The frequency of apnoea during the 1-minute time around the onset of GER was significantly higher than the frequency detected in the GER-free period (p = 0.03). Furthermore, the frequency of apnoea in the 30 seconds after GER (GER-triggered apnoeas) was greater than that detected in the 30 seconds before (p = 0.01). A great inter-individual variability was documented in the proportion of GER-triggered apnoeas. A strong correlation between total number of apnoeas and the difference between apnoeas detected 30 seconds after and before GER was found (p = 0.034).
Our data show that a variable rate of apnoeas can be triggered by GER in very preterm infants. Further studies are needed to recognise clinical features that identify those patients who are more susceptible to GER-triggered apnoeas.

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Available from: Arianna Aceti, Apr 15, 2014
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    • "In about 5% of newborns, when the reflux episodes result in injury to the esophagus or supra-esophageal structures, we can talk of Gastro-Esophageal Reflux Disease (GERD). Many clinical signs and symptoms in preterm infants have been attributed to GERD [3], including apnea [4], chronic lung disease [5], poor weight gain [6], and behavioral symptoms [7]. "
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    ABSTRACT: Background Little is known regarding the prognostic role of Multichannel Intraluminal Impedance and pH monitoring (MII/pH) parameters in preterm infants with Gastro-Esophageal Reflux Disease (GERD). Aim Our study aimed to evaluate the relationship between MII/pH variables and the duration of pharmacological therapy for GERD, in preterm infants with gestational age (GA) ≤ 34 weeks. Subjects, study design, outcome measures We retrospectively reviewed data of all newborns with GA ≤ 34 weeks that underwent MII/pH in our Neonatal Intensive Care Unit (NICU) and pharmacological treatment for GERD. We included them in a 12-month follow-up program. MII/pH parameters were used as independent variables and the duration of pharmacological therapy as dependent variable in linear regression models. Results 16 patients (GA 28.4 ± 1.8 weeks, BW 1122 ± 427 g) were enrolled into the study. Regression analysis performed on all reflux events reported a significant correlation between the duration of pharmacological treatment and MII-BEI (r2 = 0.36, p = 0.01) and MII-reflux frequency (r2 = 0.33, p = 0.02). Moreover, regression analysis performed on all events classified according to the corresponding pH change – acidic (ac.), weakly acidic ( or weakly alkaline (w.a.) – showed a significant correlation between the duration of pharmacological treatment and (r2 = 0.26, p = 0.05), reflux frequency (r2 = 0.44, p = 0.01), and MII-proximal reflux frequency (r2 = 0.35, p = 0.02). No statistically significant correlation was found between pH-Reflux Index and the duration of treatment. Conclusion The study shows how, in our population of preterm infants, MII-parameters could have not only a diagnostic role, but also a prognostic value in terms of the duration of pharmacological treatment.
    Full-text · Article · Sep 2014 · Early Human Development
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    • "Similarly, no temporal relationship has been previously observed neither between the occurrence of cardiorespiratory events and acid refluxes detected by a pH-probe [27], nor between apneas and GERs recorded by multiple intraluminal impedance (MII) monitoring [28]. Conversely, we have previously perceived an increased rate of apneas occurring within the 30 seconds following a GER episode [29]. Moreover, as we have subsequently shown [30], the number of apneas is significantly higher after nonacid GER episodes, which prevail in the early postprandial period [31], confirming Wenzl's previous findings [32]. "
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    ABSTRACT: Although gastroesophageal reflux (GER) is a very common phenomenon among preterm infants, its therapeutic management is still an issue of debate among neonatologists. A step-wise approach should be advisable, firstly promoting nonpharmacological interventions and limiting drugs to selected infants unresponsive to the conservative measures or who are suffering from severe GER with clinical complications. Despite of this, a concerning pharmacological overtreatment has been increasingly reported. Most of the antireflux drugs, however, have not been specifically assessed in preterm infants; moreover, serious adverse effects have been noticed in association to their administration. This review mainly aims to draw the state of the art regarding the pharmacological management of GER in preterm infants, analyzing the best piecies of evidence currently available on the most prescribed anti-reflux drugs. Although further trials are required, sodium alginate-based formulations might be considered promising; however, data regarding their safety are still limited. Few piecies of evidence on the efficacy of histamine-2 receptor blockers and proton pump inhibitors in preterm infants with GER are currently available. Nevertheless, a significantly increased risk of necrotizing enterocolitis and infections has been largely reported in association with their use, thereby leading to an unfavorable risk-benefit ratio. The efficacy of metoclopramide in GER's improvement still needs to be clarified. Other prokinetic agents, such as domperidone and erythromycin, have been reported to be ineffective, whereas cisapride has been withdrawn due to its remarkable cardiac adverse effects.
    Full-text · Article · Jun 2013 · Gastroenterology Research and Practice
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    • "Such as in our previous study [4], a standard period of 30″ after the onset of GOR episodes (post-GOR-time) was used to test the temporal relation between GOR and apnoea. Apnoeas detected in this period were defined as GOR-related. "
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    ABSTRACT: Apnoea of prematurity (AOP) frequently recurs in preterm infants. We have previously shown that a significant but variable proportion of AOP is induced by gastro-oesophageal reflux (GOR). The aim of this study is to evaluate the efficacy of sodium alginate in reducing the frequency of GOR-related AOP. Twenty-eight preterm infants with AOP were studied by a six-hour recording of combined multichannel intraluminal impedance and pH monitoring and polysomnography, including two three-hour postprandial periods: sodium alginate was given after one single meal named as drug-given (DG) meal, while the other as drug-free (DF). During 165h of registration, 715 apnoeas were recorded, 368 after-DG and 347 after-DF (p=.99); furthermore, 851 GOR episodes were detected, 315 after-DG and 536 after-DF (p=.001). No differences in the number of AOP were found between DG and DF. A significant reduction in the number of acid GORs and in acid exposure was found during DG, while the administration of sodium alginate didn't influence non-acid GOR indexes. The frequency of GOR-related apnoeas didn't differ between DG and DF. Sodium alginate doesn't reduce the total number of AOP nor GOR-related apnoeas. On the other hand, it reduces acid GOR features, while it had no effect on non-acid GOR indexes.
    Full-text · Article · Jun 2011 · Early human development
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