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GE Reflux and Apnea
Gastroesophageal Reflux and Apnea of Prematurity: No Temporal Relationship. Peter CS, Sprodowski N, Bohnhorst B, et al. Pediatrics 2002 (Jan); 109: 8-11.
Since most gastroesophageal reflux (GER) in premature neonates is non-acidic and therefore not detectable by pH monitoring, this study used the multiple intraluminal impedance (MII) technique to detect GER. The study investigated whether there is a temporal relationship between GER and apnea of prematurity (AOP). Nineteen infants with AOP (median EGA at birth: 30 weeks, range: 24-34 weeks; age at study: 26 days [13-93]) underwent 20 6-hour recordings of MII, breathing movements, nasal airflow, electrocardiogram, pulse oximeter saturation and pulse waveforms. Reflux episodes (RE) were defined as a fall in impedance in at least the 2 most distal channels on MII. Cardio-respiratory (CR) events were defined as apneas > 4 seconds, desaturations to < 80%, and falls in heart rate to < 100/minute. A temporal relationship between an RE and a CR event was considered present if both commenced within 20 seconds of each other.
Results. There were 2039 apneas (10-346), 188 desaturations (0-25), 44 bradycardias (0-24), and 524 RE (8-62). The frequency of apnea occurring within 20 seconds of a RE event was not significantly different from that during reflux-free epochs. The same was true for bradycardias and desaturations. Also RE occurred similarly often within 20 seconds before as after an apnea.
Comment. While GER and CR events are very common in premature babies, this study shows us that these events are not temporally related. This makes it very unlikely that there is any cause and effect relationship between these events. It follows that treating GER in preterm babies with H2 blockers or prokenetic agents is unlikely to reduce their incidence of apneas, bradycardias or desaturations. Furthermore, I can no longer see any role for esophageal pH probe studies in the evaluation of premature babies with frequent CR events. The authors remind us that almost 90% for GER episodes in neonates are non-acidic (ref. Wenzl et al, J Pediatr Gastroenterol Nutr. 1999; 28:423-28), so a negative pH probe study does not rule out significant GER. Even if you use a more sensitive method to detect GER (MII), the present study shows us that GER episodes are not likely to cause these CR events.
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