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[Comparative study of results of pH-metry in function of its indication in infants]
A Dabadie1, I Blanchot, E Goter
1Service de pédiatrie-génétique médicale, CHU Pontchaillou, Rennes, France.
Insights
Gastroesophageal reflux, measured by 24-hour pH monitoring, did not show a direct link to apparent life-threatening events (ALTE) in infants. However, the mean duration of nocturnal reflux episodes was longer in infants experiencing ALTE.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Medicine
- Diagnostic Testing
Background:
- Apparent life-threatening events (ALTE) and sudden infant death syndrome (SIDS) are critical concerns in neonates.
- Gastroesophageal reflux (GER) is a common condition in infants, but its association with severe events like ALTE is not fully understood.
Purpose of the Study:
- To investigate the relationship between gastroesophageal reflux and ALTE in infants younger than 3 months.
- To compare reflux patterns in infants with ALTE, digestive symptoms, and SIDS siblings.
Main Methods:
- 24-hour esophageal pH monitoring was conducted in four groups of infants: ALTE, ALTE with chronic digestive symptoms, digestive symptoms only, and SIDS siblings.
- Key metrics included the percentage of time esophageal pH was below 4 (% pH < 4) and the mean duration of nocturnal reflux episodes (MDNR).
Main Results:
- No significant difference was observed in the overall % pH < 4 across the four groups.
- Nocturnal reflux was present in all groups, with varying prevalence.
- The MDNR was significantly higher in infants with ALTE compared to those with only digestive symptoms or ALTE with chronic digestive symptoms.
Conclusions:
- While nocturnal reflux duration was elevated in infants with ALTE, the study failed to establish a direct causal relationship between GER and ALTE.
- MDNR in infants with ALTE and chronic digestive symptoms was similar to infants with only digestive symptoms, suggesting GER may not be the primary driver of ALTE.
Abstract:
A 24 hour pH-metry was performed in children younger than 3 months divided in 4 groups: group 1: 37 infants who presented an apparent life-threatening event (ALTE), group 2: 45 infants with an ALTE and chronic digestive symptoms (recurrent vomiting), group 3: 33 infants with digestive symptoms only, group 4: 32 sudden infant death syndrome (SIDS) siblings. The percent duration of oesophageal pH below 4 (% pH < 4) was measured during 24 hours and 12 nocturnal hours (8 PM-8 AM). In addition the mean duration of nocturnal episodes of reflux (MDNR) was calculated (duration of pH < 4 per 12 nocturnal hours/number of reflux episodes). No significant difference was found in the 4 groups for % pH < 4. Nocturnal reflux was present in all groups (40% in group 1, 55% in group 2, 49% in group 3 and 63% in group 4). The MDNR was higher in group 1 (12.3 +/- 7.8 min) vs group 2 (6.8 +/- 5.1 min) and group 3 (6.7 +/- 3.2 min) (P < 0.05). High MDNR did not appear to be related to an history of ALTE since the MDNR in group 2 was identical to group 3. Nocturnal pH metry profile failed to show a relationship between gastro-oesophageal reflux and ALTE.