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GE Reflux and Apnea of Prematurity
Di Fiore JM, Arko M, RN,
Whitehouse M, et al. Apnea Is Not Prolonged by Acid Gastroesophageal Reflux in
Preterm Infants. Pediatrics (Nov 2005); 116:1059-63. [Full
text]
Objective. To
examine the temporal relationship between apnea and gastroesophageal
reflux (GER) and to assess the effect of GER on apnea duration.
Methods. A total of 119 preterm infants underwent 12-hour
cardiorespiratory monitoring studies using respiratory inductance
plethysmography, heart rate, oxygen saturation (SaO2), and
esophageal pH. The studies were scored for GER (pH <4 for 5 seconds)
and apnea 
15
seconds or 10
seconds that occurred within 30 seconds of GER. Apnea 10
seconds was used to assess whether GER would prolong apnea duration.
Results. There were 6255 episodes of GER. Only 1% of GER episodes
were associated with apnea 15
seconds, and there was no difference in apnea rate before, during, or
after GER. There was also no difference in rate of apnea 10
seconds before versus during GER; however, there was a decrease in
apnea rate immediately after GER. The presence of GER during apnea
did not prolong apnea duration, and GER had no effect on the lowest
SaO2 or heart rate during apnea.
Conclusion. There
is no evidence of a temporal relationship between acid-based GER and
apnea in preterm infants. In addition, GER does not prolong apnea
duration and does not exacerbate the resultant decrease in heart rate
and SaO2.
Comments. Premature infants frequently have GER; in fact, it
is so common in this population that it should probably be considered
physiologic in most cases. Apnea, bradycardia and desaturation episodes are
also very common in premature infants. The data from this study suggests that
GER does not cause apnea or worsen the severity of apnea episodes. It is time
that we stop using anti-reflux medications to reduce apnea events in premature
infants. ABK
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