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Observations on gastro-oesophageal reflux, central apnoea and heart rate in infants
J Y Paton1, C S Nanayakkara, H Simpson
1Department of Child Health, University of Leicester, UK.
Insights
Gastro-oesophageal reflux (GOR) in infants is not directly linked to short central apnoeas. Studies show no causal relationship between GOR episodes and respiratory pauses, suggesting other factors like sleep influence infant breathing patterns.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Respiratory Physiology
Background:
- Gastro-oesophageal reflux (GOR) is common in infants.
- The potential link between GOR and respiratory events like apnoea requires further investigation.
Purpose of the Study:
- To investigate the relationship between gastro-oesophageal reflux (GOR) and central apnoea in infants.
- To determine if GOR directly causes respiratory pauses.
Main Methods:
- Continuous monitoring of respiratory movements and heart rate in 22 infants for 2 hours post-feed.
- Radionuclide studies were used to detect GOR events.
- Apnoea was defined as pauses in breathing lasting 3-15 seconds.
Main Results:
- Twenty infants exhibited GOR, with 19 reaching the upper oesophageal/pharyngeal level.
- Seventeen infants experienced central apnoea (3-15 seconds); no prolonged apnoea (>20s) was observed.
- No correlation found between GOR episodes and respiratory pause frequency; apnoea appeared more related to sleep.
Conclusions:
- The study found no direct cause-and-effect relationship between GOR and central apnoeas lasting less than 15 seconds in infants.
- The absence of significant bradycardia suggests obstructive apnoeas were unlikely.
- Findings indicate that GOR is not a primary cause of brief central apnoeas in this infant cohort.
Abstract:
Respiratory movements and heart rate were monitored continuously during the course of 2 h radionuclide studies to detect gastro-oesophageal reflux (GOR) in 22 infants following a milk feed. Twenty infants had GOR, to upper oesophageal/pharyngeal level in 19, and 17 had central apnoea between 3 and 15s. Prolonged central apnoea (greater than 20s) was not observed. Bradycardia, defined as a heart rate less than 80 beats/min for 10s or more, was observed in only 1 infant who did not have GOR. No correlation was found between the number or duration of reflux episodes and the frequency of respiratory pauses between 3 and 17s. When data from individual infants were examined a possible temporal relation between the occurrence of GOR and central apnoea was seen in only two infants; in each case, detailed examination suggested that apnoea was more closely associated with sleep than with GOR. Although the respiratory monitoring system did not include airflow sensors, the almost complete absence of bradycardia suggested that prolonged obstructive apnoeas did not occur. We conclude that any relation between GOR and central apnoeas less than 15 s is not of a direct cause/effect nature.