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Apnea and GE Reflux
Apnea at Discharge and Gastro-Esophageal Reflux in the Preterm Infant. Barrington KJ, Tan K, and Rich W. J Perinatol (Jan 2002); 22: 8-11.
Forth-five infants (EGA <32 weeks) were studied at an average post-menstrual age of 37.2 weeks. A 12-hour multi-channel recording including esophageal pH was obtained. Acid reflux (pH < 4) occurred at least once in all of the infants; prevalence was between 1% and 41% of the 12-hour record. The number of reflux episodes ranged from 1 – 143 (median 23). The number of apneas (>10 seconds) ranged from 0 – 71 (median 6). There was no correlation between apnea frequency or severity and reflux frequency or duration. There was no difference in apnea frequencies between the 5 minutes after the start of a reflux episode and the 5 minutes prior to each episode.
Comment. This report is similar to the study by Peter et al (Pediatrics 2002 (Jan); 109: 8-11) that was reviewed in NeoNotes 3-001. The findings are the same in both studies. While both apnea and GE reflux occur commonly in premature babies, if is unlikely that there is any cause and effect relationship between these episodes. I no longer see the logic behind doing esophageal pH studies to evaluate infants having frequent cardio-respiratory alarms. GE reflux is almost universal in premature infants, and rarely associated with significant clinical sequelae. If we look for gastro-esophageal reflux, we will probably find it. We then feel inclined to treat these infants with acid-blockers or pro-kinetic agents that have no proven efficacy in premature babies and are potentially toxic. I can see the logic behind considering anti-reflux therapy for infants who have significant emesis during and after feeds, or who have reflux-associated bronchospastic episodes, but not for preterm infants who have frequent cardio-respiratory alarms and GE reflux.
UserName: Paul Hinkes, M. D.
Date: 25 Feb 2002
Time: 13:59:52
I couldn't agree more. We do 4-channel polysomnograms on all our preemies before
discharge, and find MANY with central apneas, obstructive events, etc. We started
adding esophageal pH for babies with obstructive episodes, and our findings were exactly
the same -- lots of apneas, obstructions, etc., and lots of GER, but NO correlation
between GER and respiratory events.
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