Symptomatic gastroesophageal reflux (GER) and periodic breathing (PB) are more common in premature and younger infants. Differentiating GER from PB is important in determining treatment. One study identified a group of healthy term neonates (n=16) who presented with symptoms of GER and/or apparent life threatening event (ALTE), but only had PB. Our study analyzed PH pneumocardiograms (PHP) of 168 consecutive infants who presented with feeding related problems (vomiting, choking, gagging, back arching, cyanosis or bradycardia with feeds) and/or apnea to an urban university hospital between 1992 and 1996. The objectives include: to describe PHP in terms of diagnostic groups [GER only (G1), PB only (G2), GER and PB (G3), absence of either GER and PB (G4)], gestational age (GA), post-conceptional age (PCA), and bradycardia/desaturation (B/D) status at time of presentation and diagnosis; to analyze diagnostic differences among neonatal (N) and post-neonatal (PN) infants; to determine if PB is important in infants with symptomatic GER or ALTE. Infants ranged from ages 1.6 to 12.7 weeks of which 32% (54/168) were N[X=14.3 weeks ± 1.01 (SEM)] and 68% were PN [X= 105.8 weeks ± 6.76(SEM)]. The distribution of diagnostic groups of all the infants were as follows: 33.9% G1(n=57), 13.1% G2(n=22), 28.6% G3(n=48), and 24.4% G4(n=41). PCA means were significantly different among diagnostic groups(F=9.94;df=3;p<0.0001). G1 (X=49.09) differed significantly from both G2(X=40.73) and G3 (X=41.60). The mean PCA for infants without PB (X=49.5) and for those with PB (X=41.2) is significantly different(F=28.85;df=1;p<0.001). Mean PCA was not significantly different by the presence or absence of GER. PB alone was not observed in infants over 67 weeks PCA. Distribution of diagnostic groups between N and PN were not different using Chi-Squared test (p=0.098), but PB was more likely in N than PN (20.4% vs. 9.6%). A main effect of PB on BD status existed(F=24.71;df=1,p<0.001).

Conclusion: These results confirm that PHP rather than a 4-channel pneumocardiogram alone is necessary in the evaluation of infants who present with ALTE and/or symptoms of GER regardless of PCA or GA. Infants who are identified as having PB are more likely to have lower PCA and present with B/D.