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Gastroesophageal reflux causing respiratory distress and apnea in newborn infants
Insights
Gastroesophageal reflux in infants can cause respiratory distress and apnea. Controlling reflux through medical or surgical means improved these pulmonary conditions, suggesting a direct link.
Area of Science:
- Pediatrics
- Gastroenterology
- Pulmonology
Background:
- Infants can present with respiratory distress, apnea, and chronic pulmonary disease.
- Symptomatic gastroesophageal reflux is often comorbid with these conditions.
Purpose of the Study:
- To investigate the relationship between gastroesophageal reflux and respiratory issues in infants.
- To determine if controlling reflux improves infant pulmonary conditions.
Main Methods:
- Studied 14 infants with respiratory distress, apnea, and chronic pulmonary disease and symptomatic gastroesophageal reflux.
- Utilized esophageal pH monitoring, heart rate, impedance pneumography, and nasal airflow.
- Inducted apnea via esophageal acid instillation in a subset of patients.
Main Results:
- All infants showed radiographic changes consistent with bronchopulmonary dysplasia.
- Apnea and pulmonary disease resolved after medical or surgical reflux control.
- Reflux was observed to precede apnea, and acid instillation induced apnea.
Conclusions:
- Symptomatic gastroesophageal reflux is a significant factor in infant respiratory distress and apnea.
- Effective management of gastroesophageal reflux is crucial for improving pulmonary outcomes in affected infants.
Abstract:
Respiratory distress, apnea, and chronic pulmonary disease since birth were identified in 14 infants who also had symptomatic gastroesophageal reflux. Birth weights varied from 760 to 4,540 gm. All infants had radiographic changes similar to those in bronchopulmonary dysplasia. Cessation of apnea and improvement of pulmonary disease occurred only after medical (8) or surgical (6) control of gastroesophageal reflux. Simultaneous tracings of esophageal pH, heart rate, impedance pneumography, and nasal air flow in five infants demonstrated that reflux preceded apnea. Apnea could be induced by instillation of dilute acid, but not water or formula, into the esophagus. Prolonged monitoring of esophageal pH more than two hours after feeding in 14 other infants less than 6 weeks of age (birth weight 780 to 3,350 gm) without a history of recent vomiting indicated that reflux was not greater than in normal older children.