Related Experiment Video
Updated: Feb 16, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Cardiorespiratory events in infants with gastroesophageal reflux symptoms: Is there any association?
F Cresi1, D Martinelli2, E Maggiora1
1Neonatology and Neonatal Intensive Care Unit, Department of Public Health and Pediatrics, University of Turin, Turin, Italy.
Insights
Cardiorespiratory events and gastroesophageal reflux in infants are linked. Identifying infants with severe GER and temporal associations can guide appropriate treatment, avoiding ineffective antacid use.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Respiratory Medicine
Background:
- Cardiorespiratory (CR) events and gastroesophageal reflux (GER) frequently occur together in NICU infants.
- This comorbidity can lead to medication overuse and prolonged hospital stays.
Purpose of the Study:
- To investigate the temporal relationships between CR events and GER symptoms in infants.
- To identify specific GER characteristics associated with CR events.
Main Methods:
- Synchronized monitoring of CR events and pH-impedance for GER in symptomatic infants.
- Utilized the symptom association probability (SAP) index to quantify temporal links.
- Analyzed GER characteristics and event sequences within 30 seconds.
Main Results:
- 58 out of 66 infants experienced CR events, with 1331 CR and 5239 GER events recorded.
- A positive SAP index was found in 12% of infants, indicating significant CR-GER event associations.
- Infants with positive SAP showed increased GER frequency, duration, and proximal extent; GER preceded CR events in 83% of associations.
Conclusions:
- Simultaneous CR and GER monitoring aids in identifying infants with severe GER and significant event associations.
- GER treatment may be beneficial for these infants, particularly when GER events precede CR events.
- Non-acidic GER is common in these associations, suggesting antacids may be inappropriate.
Background:
Cardiorespiratory (CR) events (apnea, bradycardia, oxygen desaturation) and gastroesophageal reflux (GER) symptoms often coexist in infants admitted to Neonatal Intensive Care Unit, leading to over-prescription of drugs and delayed discharge. We aimed to evaluate the relationships between CR and GER events.
Methods:
The temporal associations between CR and GER events were analyzed in symptomatic infants who underwent synchronized CR and pH-impedance monitoring. The symptom association probability (SAP) index was used to identify infants with a significant number of temporal associations. Gastroesophageal reflux characteristics and the chronological sequence of CR and GER events occurring within 30 seconds of each other were evaluated according to SAP index.
Key Results:
Of the 66 infants enrolled, aged 29 (18-45) days, 58 had CR events during monitoring. From these 58 patients, a total of 1331 CR events and 5239 GER (24% acidic) were detected. The SAP index was positive in seven (12%) infants. These infants had greater GER frequency, duration, and proximal extent (P < .05). The number of temporal associations was 10 times greater in the positive SAP group. Gastroesophageal reflux events preceded CR events in 83% of these associations. These GER events had a higher proximal extent (P = .004), but showed no differences in pH values.
Conclusions & Inferences:
The simultaneous evaluation of CR and GER events could be useful to identify infants with severe GER and significant temporal associations between these events. Treatment of GER could be indicated in these infants, but as the GER events involved are mainly non-acidic, empirical treatment with antacids is, often, inappropriate.
Related Concept Videos
01:29Gastroesophageal Reflux Disease I: Meaning and Pathophysiology
01:29Gastroesophageal Reflux Disease II: Clinical Features and Management
Clinical Manifestations
GERD presents itself in a multitude of ways, with symptoms varying from person to person. The hallmark symptoms are...
01:21Barrett Esophagus-II: Clinical Manifestations and Management
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
01:30Other Disorders of Digestive System
01:17Pulmonary Cycle: Exhalation
01:30Esophageal Strictures-I: Introduction
Etiology
The primary cause of esophageal strictures is long-standing gastroesophageal reflux disease (GERD), accounting for about 70 to 80% of adult cases. Chronic acid reflux can lead to injury and scarring of the esophageal lining, culminating in...