Multichannel intraluminal impedance to detect relationship between gastroesophageal reflux and apnoea of prematurity

Magistà, Anna Maria; Indrio, Flavia; Martire, Baldassarre; Bucci, N.; Menolascina, A; Mautone, A; Francavilla, Ruggiero

doi:10.1016/j.dld.2006.12.015

Cited by 48 publications

(41 citation statements)

References 24 publications

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“…A previous study performed in a small group of preterm infants using pH-MII found an association between GER and AOP, and demonstrated that this association was mainly due to non-acid reflux [21]. Wenzl et al [8] showed that a formula thickened with carob bean gum reduced the number of non-acid GERs in infants with recurrent regurgitations.…”

Section: Discussionmentioning

confidence: 99%

A Thickened Formula Does Not Reduce Apneas Related to Gastroesophageal Reflux in Preterm Infants

et al. 2012

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Background: Apnea of prematurity (AOP) occurs frequently in preterm infants and a variable proportion of AOP can be induced by gastroesophageal reflux (GER). Conservative treatment, including dietary modifications, should be the first-line approach for both GER and GER-related apneas in this population. Objectives: To evaluate the efficacy of a starch-thickened preterm formula (PF) in reducing the frequency of apneas related to GER. Methods: Preterm infants with AOP were studied by combined impedance and pH monitoring and polysomnography. The 6-hour study period included two feeds, one of a commercially available PF and one of the same formula thickened with amylopectin (TPF). GER indexes, apneas and GER-related apneas detected after TPF and PF feeds were compared by Wilcoxon signed-rank test. Results: 24 infants were studied. During 140 h of registration, 289 apneas (147 after TPF and 142 after PF; p = 0.876), and 861 GER episodes (400 after TPF and 461 after PF; p = 0.465) were recorded. No difference in the number of AOP was found between TPF and PF. A significant reduction in acid exposure was found after TPF; there was no influence on non-acid GER indexes. The frequency of GER-related apneas did not differ between TPF and PF. Conclusions: A formula thickened with amylopectin did not reduce the number of AOP or GER-related apneas. It reduced acid GER features but had no effect on non-acid GER indexes. Future research should focus on exploring different conservative strategies to treat GER-related apneas in preterm infants.

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Section: Discussionmentioning

confidence: 99%

A Thickened Formula Does Not Reduce Apneas Related to Gastroesophageal Reflux in Preterm Infants

et al. 2012

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“…In a study using MII and pH and cardiorespiratory monitoring in prematurely born infants in the NICU, an increased frequency of apnoeas was demonstrated during periods of GOR, particularly with weakly acid reflux events and reflux events of long duration (>30 s) [23]. There were, however, no significant differences in the frequency of apnoeas in the epochs either preceding or following a reflux event (but only 6 preterm infants were investigated).…”

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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“…GERD is considered common in premature infants younger than 34 weeks gestational age, but the severity of GERD is not significantly different in symptomatic and asymptomatic infants [37,40,50]. Some authors stated that GERD is common even in premature infants younger than 32 weeks gestational age [33,34,36,41,44]. Infants with recurrent apnea have been studied at different ages, where gestational age at birth varied between 24-36 weeks and the studies have been conducted when the infants were 7-32 days old [32,43,[46][47][48].…”

Section: The Age Of the Premature Child When The Pattern Of Gerd Can mentioning

confidence: 99%

“…According to some studies, premature infants showed symptoms of GERD in terms of increased frequency of regurgitation, desaturation, apnea and bradycardia after meals [34,44]. Other studies argue that a greater number of reflux episodes per hour occur during mealtime, compared to the fasting period [50].…”

Section: Symptom Variation During the Course Of The Daymentioning

confidence: 99%

“…Other studies describe some of these symptoms as not so common/more rare, like difficulty gaining weight/failure to thrive, desaturation, "choking", "gagging", chewing, refusing to eat, irritability, showing discomfort, grimacing, and arching, cough, yawning, hiccups and sneezing [41,42]. Some studies stated that GERD and premature apnea is common in premature infants and seem to be timely related to each other, which would mean that occasions of reflux can trigger apnea in premature infants [43][44][45]. Other studies describe both apnea, bradycardia, desaturations and GERD are common in premature infants, but with few exceptions, there is no evidence for a fixed relationship between them [46,47].…”

Section: Specific Symptoms Of Gerd In Premature Infantsmentioning

confidence: 99%

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Development of an Observational Instrument to Assess Gastro-Esophageal Reflux Disease in Premature Infants

Sandberg

Öhman

2014

Int. J. Child Health Nutr.

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Background: Premature infants are at increased risk of developing Gastroesophageal Reflux Disease (GERD), which for these children is associated with a number of severe symptoms. There is great need for effective instruments and clear symptom criteria to assess the presence and degree of severity of GERD. Aim: To develop and pilot test an observation instrument for early detection of symptoms of GERD in premature infants. Method: A combination of three research methods was used – systematic literature review, observation instrument development and a pilot test. Results: The systematic review identified specific symptoms of GERD. The development of the observational instrument started with the establishment of concordance between the criteria of symptoms according to the literature review and to NIDCAP, “Newborn Individualized Developmental Care and Assessment Program”. In the pilot test the criteria of symptoms were revised by comparing the result and the criteria between infants that clinically were estimated to have had a reflux problem and the ones who did not. Conclusion: An observation instrument was developed. The clinical evaluation by a pilot test showed that the instrument could be useful to record significant symptoms and combinations of symptoms that may occur in premature infants assessed as having reflux problems.

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Multichannel intraluminal impedance to detect relationship between gastroesophageal reflux and apnoea of prematurity

Cited by 48 publications

References 24 publications

A Thickened Formula Does Not Reduce Apneas Related to Gastroesophageal Reflux in Preterm Infants

A Thickened Formula Does Not Reduce Apneas Related to Gastroesophageal Reflux in Preterm Infants

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

Development of an Observational Instrument to Assess Gastro-Esophageal Reflux Disease in Premature Infants

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