Gastroesophageal Reflux and Apnea of Prematurity – Coincidence, Not Causation

Poets, Christian F.

doi:10.1159/000343975

Cited by 9 publications

(2 citation statements)

References 24 publications

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“…The feed thickener was effective in significantly reducing the oesophageal acid exposure, but there was no significant difference in the frequency of clinically relevant apnoea [24]. Indeed, an editorial on the above paper suggested that apnoea of prematurity should not be treated with anti-reflux medications unless clear data proves a causal relationship [25]. …”

Section: Discussionmentioning

confidence: 99%

Gastro-Oesophageal Reflux and Apnoea: Is There a Temporal Relationship?

et al. 2017

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Background: Gastro-oesophageal reflux (GOR) and apnoea are common in infants; whether there is a causal relationship is controversial. Objectives: To determine whether there was a temporal relationship between GOR and apnoea, in particular, the frequency of obstructive apnoeas and if the frequency of GOR episodes correlated with apnoea frequency when maturity at testing was taken into account. Methods: Polysomnography and pH/multichannel intraluminal impedance (MII) studies were performed. Apnoeas were classified as central, obstructive, or mixed. MII events were classified as acidic (pH <4) or weakly acidic (4 < pH < 7). Apnoea frequency in the 5-min period after a reflux event was compared to that in the 5-min period preceding the event and that in a 5-min reflux-free period (control period). Results: Forty infants (median gestational age 29 [range 24-42] weeks) were assessed at a post-conceptional age of 37 (30-54) weeks. Obstructive (n = 580), central (n = 900), and mixed (n = 452) apnoeas were identified; 381 acid reflux events were detected by MII and 153 by the pH probe only. Apnoeas were not more frequent following GOR than during control periods. Both the frequency of apnoeas (p = 0.002) and GOR episodes (p = 0.01) were inversely related to post-conceptional age at testing, but were not significantly correlated with each other when controlled for post-conceptional age. Conclusions: These results suggest that GOR does not cause apnoea.

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Section: Discussionmentioning

confidence: 99%

Gastro-Oesophageal Reflux and Apnoea: Is There a Temporal Relationship?

et al. 2017

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“…Earlier studies have reported an unlikely association between reflux events and non-esophageal symptoms 32,33 and have discouraged treatment of apnea in premature babies with anti-suppressive medication. 34 Our study emphasizes that symptoms during sleep-state are likely due to non-GER related causes, and this helps us reconsider treatment of infants in intermediate group with acid suppressive medication.…”

Section: Discussionmentioning

confidence: 65%

Effect of Severity of Esophageal Acidification on Sleep vs Wake Periods in Infants Presenting with Brief Resolved Unexplained Events

Sankaran

Qureshi

Woodley

et al. 2016

The Journal of Pediatrics

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Objectives To describe the pattern of gastro-esophageal reflux (GER) events in wake and sleep states with increasing acid reflux index (ARI) in neonates and to test the hypothesis that GER-related symptoms are frequent in ARI> 7% in wake-state. Study design Infants underwent 24-hour pH-impedance studies with 6-hour concurrent video-polysomnography studies. Data were stratified based on the 24-hr ARI (% duration that esophageal pH is <4) into ARI<3% (normal), ARI 3≥ to ≤7% (intermediate) and ARI>7% (abnormal). GER frequency, clearance mechanisms and symptoms were distinguished during wake-state and sleep-state. Results Total wake and sleep duration was similar (p≥ 0.2) in all ARI groups. Acidic events were frequent with increasing ARI in wake-state vs. sleep-state (p≤ 0.03). The Symptom Index increased with increasing ARI (p≤ 0.02) in both wake-state and sleep-state. Acid clearance time increased with increasing ARI in wake-state (p≤ 0.02). In ARI>7% vs. ARI≤7%, frequency of acidic GER events was higher (p≤0.02) in wake-state and sleep-state; proximal migration of acid (p=0.03) and acid clearance time were higher in wake-state (p=0.0005) only. Symptom index was higher in ARI>7% vs. ARI≤7% in wake-state (p<0.0001), comparable in normal vs. intermediate (p=0.4) and higher in abnormal vs. intermediate (p=0.0004) groups. Conclusions Severe esophageal acid exposure (ARI>7%) is associated with increased reflux-associated symptoms in wake-state. Sleep-state appears to be protective regardless of ARI, likely due to greater chemosensory thresholds. Attention to posture and movements during wake-state can be helpful. Scrutiny for non-GER etiologies should occur for infants presenting with life-threatening symptoms.

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Neonatal Gastroesophageal Reflux

Eichenwald¹

2024

Avery's Diseases of the Newborn

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Gastroesophageal Reflux and Apnea of Prematurity – Coincidence, Not Causation

Cited by 9 publications

References 24 publications

Gastro-Oesophageal Reflux and Apnoea: Is There a Temporal Relationship?

Gastro-Oesophageal Reflux and Apnoea: Is There a Temporal Relationship?

Effect of Severity of Esophageal Acidification on Sleep vs Wake Periods in Infants Presenting with Brief Resolved Unexplained Events

Neonatal Gastroesophageal Reflux

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