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Gastroesophageal reflux and apnea in the preterm infant
1Professor of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia.
Insights
Gastroesophageal reflux (GER) and apnea are common in premature infants. Current evidence linking GER as a cause of apnea of prematurity is weak due to study limitations.
Area of Science:
- Neonatal Physiology
- Pediatric Gastroenterology
- Respiratory Medicine
Background:
- Apnea and gastroesophageal reflux (GER) are highly prevalent in preterm infants (<32 weeks gestational age).
- Apnea of prematurity stems from immature respiratory control, potentially involving the laryngeal chemoreflex.
- A hypothesis suggests a link between GER and apnea in neonates, contrasting with the cough reflex in older infants.
Purpose of the Study:
- To evaluate the current evidence for gastroesophageal reflux as a causative factor in apnea of prematurity.
- To identify challenges and requirements for future research investigating the GER-apnea relationship in preterm infants.
Main Methods:
- Review of existing studies examining the relationship between GER and apnea of prematurity.
- Analysis of methodological limitations in previous research, including study design, measurement techniques, endpoints, and patient heterogeneity.
Main Results:
- The existing evidence supporting GER as a cause of apnea of prematurity is currently considered poor.
- Multiple studies have failed to establish a definitive causal link, often due to significant methodological flaws.
Conclusions:
- Future research requires precise patient selection, accurate measurement of both acidic and non-acidic reflux events, and standardized cardiorespiratory endpoints.
- Identifying specific preterm infant subsets where GER significantly impacts respiratory control disorders necessitates rigorous study design.
Abstract:
Both apnea and gastroesophageal reflux are nearly universal in premature infants delivered before 32 weeks gestational age. Apnea of prematurity is multifactorial, secondary to immaturity of several different aspects of respiratory control. Amongst these is the laryngeal chemoreflex, when stimulated in newborns results in central and obstructive apnea as opposed to a cough reflex in older infants, an observation leading to a hypothesis that reflux and apnea may be linked. The current evidence for a role of reflux as a causative factor for apnea of prematurity is poor despite multiple studies seeking to prove a relationship. The studies have been hampered by poor design, inadequate measurement techniques and differing endpoints as well as heterogeneous patient populations. Whether subsets of premature infants can be identified in whom GER plays a larger role in disorders of respiratory control will require careful identification of specific patient populations to be studied, accurate measurement of acidic and non-acidic reflux events, and strict definitions of cardiorespiratory endpoints.
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