Apneas not increased after feeds

Apneas not increased after feeds

C Slocum, M Arko, J Di Fiore, et al. Apnea, bradycardia and desaturation in preterm infants before and after feeding. J. Perinatol (March 2009); 29: 209-212.

Objective: A common clinical impression is that both gastroesophageal reflux (GER) and cardiorespiratory events increase after feeding in preterm infants. We aimed to measure objectively the effects of feeding on GER, apnea, bradycardia and desaturations.

Study Design: We conducted a retrospective review of premature infants with a gestational age of 23 to 37 weeks at birth and a post-conceptional age of 34 to 48 weeks, who were referred for multichannel intraluminal impedance (MII), pH probe and 12-h apnea evaluation. Cardiorespiratory and GER event rates during pre- and post-feeding intervals were compared.

Result: Thirty-six infants met the inclusion criteria. More GER events occurred after a feed than before (P=0.012). After feeds, reflux was less acidic and higher in the esophagus (P<0.05). In contrast, the rates of apnea, bradycardia and desaturations were not altered by infant feeding. Apnea of >5 s occurred at a median frequency of 0 (range 0 to 3) events per hour before a feed and 0 (0 to2) events per hour after a feed (P=0.61).

Conclusion: The frequency, height and pH of GER are significantly altered by feedings in preterm infants. However, the common clinical impression that apnea, bradycardia and desaturations are more prevalent after feeding is not supported.

Comments: We have now reviewed at least 7 articles demonstrating the lack of an association between GE reflux events and episodes of apnea and bradycardia in preterm infants (see also 3-001; 3-011; 3-012; 5-011; 6-041; 7-033). The present study does demonstrate an increase in GER events after feeding (as you would expect), but no increase in apnea, bradycardia or desaturations in the post-prandial period. So why do we continue to do PH probe evaluations in preemies with persistant apnea events? Another important question: Why do we continue to treat GE reflux in preemies with potentially harmful medications. Don’t we have enough studies to convince ourselves that GER in preemies is usually physiologic, and is not likely to cause apnea and bradycardia events? ABK

Additional Comments:

Date: 21 May 2009
Time: 17:33:56

Agree fully with ABK comments. At SPR 2009, Richard Martin et al. presented another large cohort again showing minimal to no link between GER and A/Bs.

UserName: Gregory Moore
Institution: Children's Hospital of Eastern Ontario, Ottawa, Canada
email: gmoore@cheo.on.ca

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