Abstract 1407 Poster Session I, Saturday, 5/1 (poster 7)

Monitor events (apnea, bradycardia or desaturation) are often considered markers of gastroesophageal reflux (GER) in newborns. We reviewed 145 consecutive 5-channel overnight pneumograms for the association of reflux with specific cardiorespiratory events. 113 of 145 studies (78%) were pre-discharge pneumograms in low birth weight infants with residual monitor events, and 32/145 (22%) were in term infants with apparent life-threatening events. pH probe placement was verified by an AP chest x-ray. GER was defined as an episode of lower esophageal pH <4.0 for at least 6 seconds, and was reported as a percentage of total study time. Routine care and feeding were maintained during each study. Each 12-hour tracing was analyzed and scored by computer, then evaluated visually for final interpretation by one of the authors. Patients were grouped by the amount of reflux detected as <5% (n=82); 5-10% (n=25) or >10% (n=38; range 10.3-44.5%). The proportion of term to preterm infants (23%, 25%, and 21%, respectively) was the same all 3 groups. No specific cardiorespiratory variable was correlated with increased GER. The incidence of periodic breathing, bradycardia or desaturation, and obstructive apnea did not correlate reliably with the incidence of reflux, either within or between patient groups. Recommendations to begin or continue medical management for reflux were based on the frequency of reflux or on observations of cardiorespiratory instability during reflux periods, but not on any quantitative measurement of apnea, bradycardia, or desaturation. Results are shown in the Table:

Table 1 No caption available
Full size table

Conclusions: The clinical inference that apnea events are frequent markers of GER in newborns is not supported by these observations, and may lead to overuse of reflux management. Most reflux episodes seen in these studies were unrelated to the monitor events for which overnight pneumograms were requested.