Published online November 1, 2005
PEDIATRICS Vol. 116 No. 5 November 2005, pp. 1059-1063 (doi:10.1542/peds.2004-2757)
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Apnea Is Not Prolonged by Acid Gastroesophageal Reflux in Preterm Infants

Juliann M. Di Fiore, BSEE*, Marina Arko, RN, BSN*, Meghan Whitehouse, BS{ddagger}, Amy Kimball, MD§ and Richard J. Martin, MD||

* Department of Pediatrics, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio
{ddagger} Shaker Heights, Ohio
§ Salt Lake City, Utah
|| Departments of Pediatrics, Reproductive Biology, Physiology, and Biophysics, Case Western Reserve University School of Medicine, and Division of Neonatology, Rainbow Babies & Children's Hospital, Cleveland, Ohio

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.

Key Words: apnea • gastroesophageal reflux • neonates

Abbreviations: GER, gastroesophageal reflux • SaO2, oxygen saturation • ANOVA, analysis of variance

Accepted Jan 24, 2005.


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