Gastroesophageal Reflux and Apnea in Prematurely Born Infants During Wakefulness and Sleep

Ajuriaguerra, M de; Radvanyi-Bouvet, Marie-France; Huon, Catherine; Moriette, G

doi:10.1001/archpedi.1991.02160100064024

Cited by 31 publications

(38 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Especially after feedings, re¯ux will not be documented by pH monitoring. 10,16,21 The aim of this study was to investigate the temporal association of apnea and gastroesophageal re¯ux in infants, by combining the pH-independent intraluminal impedance technique 21,22 with polygraphic recordings meant to detect apnea.…”

Section: Introductionmentioning

confidence: 99%

Association of apnea and nonacid gastroesophageal reflux in infants: Investigations with the intraluminal impedance technique

et al. 2001

View full text Add to dashboard Cite

Section: Introductionmentioning

confidence: 99%

Association of apnea and nonacid gastroesophageal reflux in infants: Investigations with the intraluminal impedance technique

et al. 2001

View full text Add to dashboard Cite

“…No significant differences were found in the proportions of infants who had apnea between those with and without GER (10). Most other studies have also failed to document a temporal relationship between apnea and GER (17)(18)(19)(20)(21)(22)(23). We now highlight that there is no such relationship in either the prone or, importantly, the supine position in convalescent, prematurely born infants.…”

Section: Discussionmentioning

confidence: 55%

Acid Gastroesophageal Reflux in Convalescent Preterm Infants: Effect of Posture and Relationship to Apnea

et al. 2007

View full text Add to dashboard Cite

Concerns regarding gastroesophageal reflux (GER) and associated apnea episodes result in some practitioners having convalescent, prematurely born infants sleep in the prone position. We have tested the hypothesis that such infants would not suffer from clinically important acid GER or associated apnea episodes more in the supine compared with the prone position. Lower esophageal pH was measured and videopolysomnographic recordings of nasal airflow, chest and abdominal wall movements, electrocardiographic activity, and oxygen saturation were made on two successive days of 21 premature infants (median gestational age 28 wk) at a median postmenstrual age (PMA) of 36 wk. On each day, the infants were studied prone and supine. The acid reflux index was higher in the supine compared with the prone position (median 3% versus 0%, p ϭ 0.002), but was low in both positions. The number of obstructive apnea episodes per hour was higher in the supine position (p ϭ 0.008). There were, however, no statistically significant correlations between the amount of acid GER and the number of either obstructive or total apnea episodes in either the supine or prone position. Supine compared with prone sleeping neither increases clinically important acid GER nor obstructive apnea episodes associated with acid GER in asymptomatic, convalescent, prematurely born infants. (Pediatr Res 62: 620-623, 2007) P rematurely born infants are at increased risk of sudden infant death syndrome (SIDS), particularly if they sleep in the prone position (1). Despite this known adverse association, some prematurely born infants still sleep in the prone position at the age when they are at highest risk of SIDS (2). Several studies have highlighted that parents are strongly influenced by health care practitioners with regard to their choice of sleeping position for their infant (3,4). Worryingly, the results of a national survey (5) revealed that in some neonatal units, prematurely born infants slept in the prone position even just before discharge from the neonatal intensive care unit (NICU). One of the reasons given for continuation of prone sleeping is the perceived increased risk of gastroesophageal reflux (GER) in the supine position (6) and that the likelihood of associated problems such as apnea may be less in the prone position. Yet, it is known that there is maturation of the reflexes that protect against GER and esophagopharyngeal reflux (7). Esophageal and upper esophageal sphincter motor responses to abrupt mid-esophageal provocation are present as early as 33 wk PMA, and the response characteristics improve during development (7). We, therefore, hypothesized that convalescent, asymptomatic, prematurely born infants ready for NICU discharge would not suffer from either clinically important acid GER or apnea episodes associated with acid GER more in the supine compared with the prone position. The aim of this study was to test that hypothesis by investigating the influence of sleeping position on acid reflux and any association with apnea...

show abstract

“…Data from 289 infants (five studies reported gestational age: range 24–43 weeks, one reported postnatal age: range 1–34 weeks) were included. Studies were conducted in tertiary centers in The United States of America and Europe …”

Section: Resultsmentioning

confidence: 99%

Association between gastroesophageal reflux and pathologic apneas in infants: a systematic review

Smits

Wijk

Langendam

et al. 2014

Neurogastroenterology Motil

View full text Add to dashboard Cite

To perform a systematic review using PubMed, EMBASE and Cochrane databases to determine whether an association between GER and apnea in infants exists. Studies with n ≥ 10 infants, aged <12 months, were included. GER had to be studied by pH-metry or pH-impedancemetry. GER episodes were defined as pH <4 for ≥ 5 s and/or a drop of >50% of baseline in impedance signal in distal channels. An apneic event was defined as a cessation of breathing for >20 s, or ≥ 10 s with hypoxemia or bradycardia. An epoch of ≤ 2 min was used to define temporal relation between GER and apnea. Methodological quality of studies was assessed with Newcastle Ottawa Scale (NOS). Of 1959 abstracts found, 6 articles met the inclusion criteria. All studies had poor methodological quality. A total of 289 infants were included. The temporal association of GER followed by apnea was assessed in all studies, with epochs varying from 10 s to 2 min. One study found an increase of apneic events after GER, the remaining 5 studies did not find an association. Two studies assessed apnea followed by GER as well, but did not find sufficient evidence for association. This systematic review showed insufficient evidence for an association between GER and apneas in infants. High quality studies using uniform inclusion criteria, definitions according to accepted guidelines, and patient relevant outcome measures are needed.

show abstract

Gastroesophageal Reflux and Apnea in Prematurely Born Infants During Wakefulness and Sleep

Cited by 31 publications

References 27 publications

Association of apnea and nonacid gastroesophageal reflux in infants: Investigations with the intraluminal impedance technique

Association of apnea and nonacid gastroesophageal reflux in infants: Investigations with the intraluminal impedance technique

Acid Gastroesophageal Reflux in Convalescent Preterm Infants: Effect of Posture and Relationship to Apnea

Association between gastroesophageal reflux and pathologic apneas in infants: a systematic review

Contact Info

Product

Resources

About