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Bradycardia and gastroesophageal reflux in term and preterm infants: is there any relation?
Insights
Acid gastroesophageal reflux rarely causes significant heart rate changes in infants. Most reflux episodes were not linked to heart rate events like bradycardia in preterm and term infants.
Area of Science:
- Neonatal Physiology
- Pediatric Gastroenterology
Background:
- Conflicting data exist on acid gastroesophageal reflux's impact on infant heart rate.
- Gastroesophageal reflux disease (GERD) symptoms are common in infants, potentially affecting cardiorespiratory function.
Purpose of the Study:
- To investigate the relationship between acid gastroesophageal reflux and heart rate changes in symptomatic preterm and term infants.
- To compare heart rate responses to reflux in preterm versus term infants at similar postconceptional ages.
Main Methods:
- Simultaneous monitoring of esophageal pH and heart rate in 50 infants (25 preterm, 25 term) with GERD symptoms.
- Infants were assessed at a postconceptional age of 47-49 weeks.
- Defined significant bradycardia and relative bradycardia episodes.
Main Results:
- No significant bradycardia events were recorded.
- 71 relative bradycardia episodes were detected, none prolonged (>5s).
- Acid reflux occurred in 92% of infants; most episodes were not temporally associated with heart rate changes. Preterm infants had more relative bradycardia episodes, but no difference in reflux or simultaneous events was found between groups.
Conclusions:
- Acid gastroesophageal reflux is generally not time-related to significant heart rate changes in symptomatic infants.
- Relative bradycardia episodes are infrequent and brief, with no strong association with reflux events.
- Findings suggest that GERD is unlikely to be a primary cause of significant heart rate disturbances in this infant population.
Abstract:
Conflicting data are published regarding the influence of acid gastroesophageal reflux on the heart rate. In this study, heart rate was monitored simultaneously with esophageal pH in 50 infants with symptoms suggestive of gastroesophageal reflux disease (frequent vomiting and regurgitations). The data of 25 preterm infants (born at 28-36 6/7 weeks) were compared to those of 25 term infants (born after 37 weeks of gestation). However, both groups were investigated at identical postconceptional age of 47-49 weeks. Not one significant bradycardia (heart rate < or = 80/min during > or = 10 s) was recorded, although 71 "relative bradycardia episodes" (heart rate < or = 80/min during > or = 5 beats) were detected, none lasting for > 5 s. Although the number of infants with relative bradycardia episodes did not differ between groups, the relative bradycardia episodes occurred more frequently in some preterm infants (53 episodes in preterm infants vs. 18 in term babies). Acid gastroesophageal reflux episodes were observed in 46 infants (92%). Neither the number of reflux episodes nor their duration was different in both groups. Simultaneous relative bradycardia episodes and acid reflux episodes were observed in three of 23 preterm and two of 23 term infants (NS). It is concluded that in a population of preterm and term infants with symptoms suggestive of a moderate gastroesophageal reflux pathology, investigated at comparable postconceptional age, most reflux episodes are not time-related to changes in heart rate.