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The risk of sudden infant death from gastroesophageal reflux
S G Jolley1, L M Halpern, W P Tunell
1Department of Surgery, Humana Children's Hospital, Las Vegas, NV.
Insights
Gastroesophageal reflux (GER) is linked to infant deaths and SIDS. Surgery for type I GER with prolonged reflux duration significantly reduced SIDS deaths compared to nonoperative treatment.
Area of Science:
- Pediatrics
- Gastroenterology
- Neonatology
Background:
- Gastroesophageal reflux (GER) is a suspected contributor to infant mortality, including sudden infant death syndrome (SIDS).
- Understanding the relationship between GER patterns and infant death is crucial for effective clinical management.
Purpose of the Study:
- To investigate the association between GER patterns, reflux duration, and infant mortality, including SIDS.
- To evaluate the impact of antireflux surgery versus nonoperative management on outcomes in infants with specific GER characteristics.
Main Methods:
- A retrospective analysis of 10-year data from 499 infants (≤6 months) undergoing extended esophageal pH monitoring.
- Data included GER patterns (Type I, II, III), pH score, and mean reflux duration during sleep (ZMD).
- Infant mortality causes and occurrence during the first year of life were tracked.
Main Results:
- Five of 19 deaths were directly linked to reflux (aspiration) or SIDS, all with prolonged ZMD (>3.8 min).
- Infants with Type I GER and prolonged ZMD treated nonoperatively had a 9.1% incidence of reflux-related/SIDS deaths.
- Antireflux surgery in the same infant group resulted in a statistically significant reduction in deaths (0%, P = .03).
- SIDS incidence was significantly higher in infants with Type I GER and prolonged ZMD treated nonoperatively (6.8%) compared to other nonoperatively treated infants (0%, P = .003).
Conclusions:
- Prolonged ZMD and Type I GER pattern are associated with increased risk of SIDS and reflux-related deaths in infants.
- Antireflux surgery appears to be a protective factor against mortality in high-risk infants with Type I GER and prolonged reflux.
- These findings underscore the importance of aggressive management for infants exhibiting specific GER indicators associated with mortality risk.
Abstract:
Gastroesophageal reflux (GER) has been a suspected cause of infant deaths and sudden infant death syndrome (SIDS). We examined our 10-year experience with 499 consecutive infants 6 months of age or less who had extended (18 to 24 hours) esophageal pH monitoring performed to evaluate for GER. The data extracted from the esophageal pH records included the pH score, the pattern of GER (type I, II, or III), and the mean duration of reflux during sleep (ZMD). All infants were followed to determine the occurrence and cause of death during the first year of life. Of the 19 deaths found in the series, three were classified as SIDS and two were in-hospital deaths caused by reflux-induced aspiration. All five of these infants who died had a prolonged ZMD (greater than 3.8 minutes) and received either basic medical (n = 4) or no (n = 1) antireflux therapy. Four infants also had the type I pattern of GER. There was a 9.1% (4/44; 95% confidence limits, 2.5% to 21.7%) incidence of reflux-related or SIDS deaths in infants with type I GER and a prolonged ZMD who were treated nonoperatively, compared with none (0/83, P = .03) in the same group of infants treated with antireflux surgery. The incidence of SIDS was higher in infants with type I GER and a prolonged ZMD who were treated nonoperatively (3/44, 6.8%) compared with all other infants treated nonoperatively (0/265, 0%; P = .003).(ABSTRACT TRUNCATED AT 250 WORDS)
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