The frequency of apneas in very preterm infants is increased after non-acid gastro-esophageal reflux

Corvaglia, Luigi; Zama, Daniele; Spizzichino, M.; Aceti, Arianna; Mariani, Elisa; Capretti, Maria Grazia; Galletti, Silvia; Faldella, Giacomo

doi:10.1111/j.1365-2982.2010.01650.x

Cited by 36 publications

(21 citation statements)

References 23 publications

(45 reference statements)

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“…We have previously shown [4] that apneas occur more frequently after than before GER episodes, and that non-acid GER, which is prevalent soon after feeding [6], is a more powerful trigger for apneas than acid GER [5]. We hypothesized that GERs occurring in the early postprandial period could easily evoke an apnea by a mechanism related to the mechanical distension of the mid-esophagus and independent from their acidity [5].…”

Section: Discussionmentioning

confidence: 99%

“…We hypothesized that GERs occurring in the early postprandial period could easily evoke an apnea by a mechanism related to the mechanical distension of the mid-esophagus and independent from their acidity [5]. …”

Section: Discussionmentioning

confidence: 99%

“…As previously described [4,5], apneas detected in the 30 s after each GER episode (post-GER time) were defined as GER-related. The choice of this short time period reduced the risk that other factors occurring in a longer time window could mask the relationship between GER and apnea.…”

Section: Methodsmentioning

confidence: 99%

“…The relationship between AOP and gastroesophageal reflux (GER) is still controversial [2,3,4]: in a previous study, we have shown that the proportion of apneas triggered by GER is highly variable among preterm infants [4], while other studies have failed to show a causal relationship between the two events [2]. In our experience, non-acid GER appears to be a more effective trigger for apnea than acid GER [5]; it occurs mainly soon after feeding [6], and is often associated with breathing irregularities [7]. …”

Section: Introductionmentioning

confidence: 99%

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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%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2012

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“…the severity of GER was not predictive of AOP. In a subsequent investigation, the authors found no significant difference in the duration or esophageal height of GER episodes associated with, versus without, apnea [10]. …”

mentioning

confidence: 99%

Gastroesophageal Reflux and Apnea of Prematurity – Coincidence, Not Causation

Poets¹

2012

Neonatology

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Critical Ill Infants with Gastro-Oesophageal Reflux Disease

Preiser¹,

Ryckere²

2015

Diet and Nutrition in Critical Care

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The frequency of apneas in very preterm infants is increased after non-acid gastro-esophageal reflux

Abstract: Non-acid GER is responsible for a variable amount of AOP detected after-GER: this novel finding must be taken into consideration when a therapeutic strategy for this common problem is planned.

Cited by 36 publications

References 23 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

Gastroesophageal Reflux and Apnea of Prematurity – Coincidence, Not Causation

Critical Ill Infants with Gastro-Oesophageal Reflux Disease

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