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[Esophageal function of infants with sudden infant death--risk]
U Landler1, M E Höllwarth, E Uray
1Univ. Klinik f. Kinderchirurgie, Graz.
Insights
Infants with near-miss events for Sudden Infant Death Syndrome (SIDS) exhibit more esophageal motor dysfunction and delayed gastric clearance compared to infants with apnea and cyanosis.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Medicine
- Sleep Medicine
Context:
- Sudden Infant Death Syndrome (SIDS) remains a significant concern in infant mortality.
- Understanding the physiological underpinnings of SIDS risk factors is crucial for prevention.
- Near-miss events and apneic spells with cyanosis are indicators of potential SIDS risk.
Purpose:
- To compare respiratory and esophageal function in infants at risk for SIDS.
- To differentiate between infants experiencing near-miss events and those with apnea and cyanosis during sleep.
- To investigate esophageal motor function and gastric clearance in these at-risk infant groups.
Summary:
- Both near-miss and apnea/cyanosis groups showed early pathologic breathing patterns but similar apnea parameters.
- Near-miss infants had significantly more manometric refluxes, particularly non-acidic ones, and disturbed esophageal peristalsis.
- Apnea/cyanosis infants exhibited more significant acid reflux events, possibly due to faster gastric emptying.
Impact:
- Near-miss infants demonstrate more pathological esophageal motor function than infants with apnea and cyanosis.
- Findings suggest delayed gastric clearance in near-miss infants, a potential contributing factor to their risk.
- This research aids in differentiating physiological profiles of infants at risk for SIDS.
Abstract:
In 24 patients at risk for SIDS (12 infants with a near miss event and 12 infants with apnea and perioral cyanosis during sleep) respiratory and esophageal function were investigated by impedance pneumography (IP) and esophageal manometry combined with simultaneous pH-monitoring (EMPH). Both groups had ad early pathologic breathing pattern, but did not show any difference in the recorded parameters (number of apneic spells, longest apneic spell, apneic spells longer than 10 seconds, transcutaneous oxygen pressure, mean apnea time). Near miss infants had about 50% more manometric refluxes (15.4 +/- 1.3) than the apnea/cyanosis group (9.9 +/- 2.2). This difference was mainly caused by a significant rise of reflux episodes without pH-change (near miss 8.5 +/- 3.1 versus 2.9 +/- 1.4 in apnea/cyanosis infants). Furthermore, propulsive peristaltic properties after induced swallows were more disturbed in the near miss group (3.3 +/- 1.0 versus 6.1 +/- 1.9). On the other hand, the apnea cyanosis group showed significantly more pH-drops under 4 (6.8 +/- 2.3 vs 2.4 +/- 0.7), which might be due to a more rapid clearance of neutralising milk from the stomach in these infants. In conclusion the study showed that infants with a near miss event in the anamnesis suffer from a more pathologic esophageal motor function when compared with infants with apneic spells and cyanosis during sleep. Near miss infants are also considered to have a delay of gastric clearance.