Correlation between cardiorespiratory events and gastro-esophageal reflux in preterm and term infants: Analysis of predisposing factors
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S Nobile1, P Marchionni2, C Noviello3
1Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy; Department of Woman and Child Health and Public Health, Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy.
Insights
Gastro-esophageal reflux (GER) and cardiorespiratory events (CRE) are associated in less than 11% of neonates. Ponderal growth may help predict this association in infants.
Area of Science:
- Neonatal medicine
- Pediatric gastroenterology
- Respiratory medicine
Background:
- The relationship between cardiorespiratory events (CRE) and gastro-esophageal reflux (GER) in neonates remains debated.
- Investigating this association is crucial for understanding infant health and developing targeted interventions.
Purpose of the Study:
- To investigate the association between GER and CRE in both preterm and term infants.
- To determine the incidence and characteristics of CRE temporally linked to GER episodes.
Main Methods:
- A prospective observational study involving 47 infants with suspected GER and recurrent CRE.
- Simultaneous 24-hour monitoring of heart rate, oxygen saturation, and pH-impedance was performed.
- Symptom association probability (SAP) was calculated using a 2-minute window to assess the link between GER and CRE.
Main Results:
- A total of 3341 GER events and 4936 CRE were recorded; 12% of CRE were temporally associated with GER.
- The symptom association probability (SAP) index was significant in only 11% of infants.
- Infants with a positive SAP index showed lower weight gain prior to the test and tended to have lower birth weight.
Conclusions:
- Gastro-esophageal reflux (GER) and cardiorespiratory events (CRE) are associated in a small subset of infants (<11%).
- Ponderal growth evaluation may serve as a predictive factor for the association between GER and CRE in neonates.
Background:
The association between cardiorespiratory events (CRE) and gastro-esophageal reflux (GER) among neonates is still controversial.
Aims:
To test such an association in preterm and term infants.
Study Design:
Prospective observational study.
Subjects:
Forty-seven infants with suspected GER and recurrent CRE admitted at a neonatal intensive care unit, who underwent simultaneous and synchronized 24-hour recording of heart rate (HR), peripheral oxygen saturation (SpO2) and pH-impedance monitoring (MII-pH). HR/SpO2 data were filtered to avoid artefactual episodes of hypoxia and hypoperfusion.
Outcome Measures:
The main outcome measure was the symptom association probability (SAP), with a 2-minute time window. Infants with positive (>95%) and negative (≤95%) SAP index tests were compared by univariate and multivariate statistics.
Results:
Median gestational age at birth was 294/7 weeks, median age at study 36 days. We recorded 3341 GER events and 4936 CRE (4710 desaturations, 226 bradycardias); 609/4936 (12%) CRE were temporally associated with GER episodes: 338 preceded and 271 followed GER events. The SAP index was significant in 5/47 (11%) patients. The SAP index including only CRE following GER events was significant in 3/47 (6%). There was no significant difference in the number of acid, weakly acid, non-acid, pH-only events preceding or following CRE between infants with SAP-positive and SAP-negative tests. Infants with positive SAP-index tests compared to those with SAP-negative tests had lower weight gain in the three days preceding the test and tended to have lower birth weight.
Conclusions:
GER and CRE were associated in <11% of patients. The evaluation of ponderal growth might be helpful in predicting such an association.
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