Infant apnea and gastroesophageal reflux: A critical review and framework for further investigation
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Gastroesophageal reflux and apnea of prematurity are both common occurrences in premature infants. However, a causal relationship between the two remains controversial. Strong physiologic evidence indicates that a variety of protective reflex responses may elicit laryngeal adduction and apnea. Although a potential link between gastroesophageal reflux and apnea may exist through this pathway, clinical studies can be cited to either support or refute such a link in premature infants. The majority of gastroesophageal reflux episodes do not appear to be related to apnea. In a specific subset of events, a causal relationship may exist. Whether this is related to the character of the reflux episode or to a predisposition in a subpopulation of infants is unclear. This review presents the evidence for and against an association between gastroesophageal reflux and apnea, discusses techniques used in their evaluation, and identifies approaches for future investigation.
- Herbst JJ, Minton SD, Book LS: Gastroesophageal reflux causing respiratory distress and apnea in newborn infants. J Pediatr 1979, 95:763–768. CrossRef
- Leape LL, Holder TM, Franklin JD, et al.: Respiratory arrest in infants secondary to gastroesophageal reflux. Pediatrics 1977, 60:924–928.
- Fuloria M, Hiatt D, Dillard RG, O’shea TM: Gastroesophageal reflux in very low birth weight infants: association with chronic lung disease and outcomes through 1 year of age. J Perinatol 2000, 20:235–239. CrossRef
- Spitzer AR, Boyle JT, Tuchman DN, Fox WW: Awake apnea associated with gastroesophageal reflux: A specific clinical syndrome. J Pediatr 1984, 104:200–205. CrossRef
- Menon AP, Schefft GL, Thach BT: Apnea associated with regurgitation in infants. J Pediatr 1985, 106:625–629 CrossRef
- Harris P, Munoz C, Mobarec S, et al.: Relevance of the pH probe in sleep study analysis in infants. J Pediatr 2004, 30:337–344.
- Peter CS, Sprodowski N, Bohnhorst B, et al.: Gastroesophageal reflux and apnea of prematurity: No temporal relationship. Pediatrics 2002, 109:8–11. CrossRef
- Mousa H, Woodley FW, Metheney M, Hayes J: Testing the association between gastroesophageal reflux and apnea in infants. J Pediatr Gastroenterol Nutr 2005, 41:169–177. CrossRef
- Wenzl TG, Schenke S, Peschgens T, et al.: Association of apnea and nonacid gastroesophageal reflux in infants: Investigations with the intraluminal impedance technique. Pediatr Pulmonol 2001, 31:144–149. CrossRef
- Clark RH, Bloom BT, Spitzer AR, Gerstmann DR: Reported medication use in the neonatal intensive care unit: data from a large national data set. Pediatrics 2006, 117:1979–1987. CrossRef
- Malcolm W, Gantz M, Das A, et al.: Anti-reflux medications (ARM) at NICU discharge for extremely low birthweight (ELBW) infants. Presented at the Academic Society for Pediatric Research. San Francisco, CA. April 2006.
- Vandeplas Y, Sacre-Smits L: Continuous 24-hour esophageal pH monitoring in 285 asymptomatic infants 0–15 months old. J Pediatr Gastroenterol Nutr 1987, 6:220–224. CrossRef
- Lopez-Alonso M, Moya MJ, Cabo JA, et al.: Twenty-four-hour esophageal impedance-pH monitoring in healthy preterm neonates: rate and characteristics of acid, weakly acidic, and weakly alkaline gastroesophageal reflux. Pediatrics 2006, 118:e299–e308. CrossRef
- Orenstein SR: Infantile reflux: Different from adult reflux. Am J Med 1997, 103(5A):114S–119S. CrossRef
- Poets CF: Gastroesophageal reflux: A critical review of its role in preterm infants. Pediatrics 2004, 113:128–132. CrossRef
- Omari TI, Benninga MA, Barnett CP, et al.: Characterization of esophageal body and lower esophageal sphincter motor function in the very premature neonate. J Pediatr 1999, 135:517–521. CrossRef
- Omari TI, Barnett CB, Snel A, et al.: Mechanisms of gastroesophageal reflux in healthy premature infants. J Pediatr 1998, 133:650–654. CrossRef
- Omari TI, Barnett CP, Benninga MA, et al.: Mechanisms of gastroesophageal reflux in preterm and term infants with reflux disease. Gut 2002, 51:475–479. CrossRef
- Omari T, Snel A, Barnett C, et al.: Measurement of upper esophageal sphincter tone and relaxation during swallowing in premature infants. Am J Physiol 1999, 277:G862–G866.
- Omari TI, Miki K, Fraser R, et al.: Esophageal body and lower esophageal sphincter function in healthy premature infants. Gastroenterology 1995, 109:1757–1764. CrossRef
- Peter CS, Wiechers C, Bohnhorst B, et al.: Influence of nasogastric tubes on gastroesophageal reflux in preterm infants: a multiple intraluminal impedance study. J Pediatr 2002, 141:277–279. CrossRef
- Ewer AK, Durbin CM, Morgan ME, Booth IW: Gastric emptying and gastro-oesophageal reflux in preterm infants. Arch Dis Child Fetal Neonatal Ed 1996, 75:F117–F121. CrossRef
- Grant L, Cochran D: Can pH monitoring reliably detect gastroesophageal reflux in preterm infants? Arch Dis Child Fetal Neonatal Ed 2001, 85:F155–F157. CrossRef
- Mitchell DJ, McClure BG Tubman TR: Simultaneous monitoring of gastric and oesophageal pH reveals limitations of conventional oesophageal pH monitoring in milk fed infants Arch Dis Child 2001, 84:273–276. CrossRef
- Condino AA, Sondheimer J, Pan Z, et al.: Evaluation of infantile acid and nonacid gastroesophageal reflux using combined pH monitoring and impedance measurement. J Pediatr Gastroenterol Nutr 2006, 42:16–21. CrossRef
- Wenzl TG, Moroder C, Trachterna M, et al.: Esophageal pH monitoring and impedance measurement: a comparison of two diagnostic tests for gastroesophageal reflux. J Pediatr Gastroenterol Nutr 2002, 34:519–523. CrossRef
- Vandenplas Y, Salvatore S, Vieira MC, Hauser B: Will esophageal impedance replace pH monitoring? Pediatrics 2007, 119:118–122. CrossRef
- Peter CS, Wiechers C, Bohnhorst B, et al.: Detection of small bolus volumes using multiple intraluminal impedance in preterm infants. J Pediatr Gastroenterol Nutr 2003, 36:381–384. CrossRef
- Peter CS, Sprodowski N, Ahlborn V, et al.: Inter-and intraobserver agreement for gastroesophageal reflux detection in infants using multiple intraluminal impedance. Biol Neonate 2004, 85:11–14. CrossRef
- Consensus Statement: National Institutes of Health consensus development conference on infantile apnea and home monitoring, Sept 29–Oct 1, 1986. Pediatrics 1987, 79:292–299.
- Martin RJ, Abu-Shaweesh JM: Control of breathing and neonatal apnea Biol Neonate 2005, 87:288–295. CrossRef
- Abu-Shaweesh JM: Maturation of respiratory reflex responses in the fetus and neonate. Senmin Nenonatol 2004, 9:169–180. CrossRef
- St-Hilaire M, Nsegbe E, Gagnon-Gervais K, et al.: Laryngeal chemoreflexes induced by acid, water, and saline in nonsedated newborn lambs during quiet sleep. J Appl Physiol 2005, 98:2197–2203. CrossRef
- Downing SE, Lee JC: Laryngeal chemosensitivity: a possible mechanism for sudden infant death. Pediatrics 1975, 55:640–649.
- Abu-Shaweesh JM, Dreshaj IA, Haxhiu MA, Martin RJ: Central GABAergic mechanisms are involved in apnea induced by SLN stimulation in piglets. J Appl Physiol 2001, 90:1570–1576.
- Davies AM, Koenig JS, Thach BT: Characteristics of upper airway chemoreflex prolonged apnea in human infants. Am Rev Respir Dis 1989, 139:668–673.
- Pickens DL, Schefft G, Thach BT: Prolonged apnea associated with upper airway protective reflexes in apnea of prematurity. Am Rev Respir Dis 1988, 137:113–118.
- Thompson DM, Rutter MJ, Rodolph CD, et al.: Altered laryngeal sensation: a potential cause of apnea of infancy. Ann Otol Rhinol Laryngol 2005, 114:258–263.
- Kimball AL, Carlton DP: Gastroesophageal reflux medications in the treatment of apnea in premature infants. J Pediatr 2001, 138:355–360. CrossRef
- Haxhiu MS, Erokwu BO, Cherniack NS: The brainstem network involved in coordination of inspiratory activity and cholinergic outflow to the airways. J Auton Nerv Syst 1996, 61:155–161. CrossRef
- Haxhiu-Poskurica B, Carlo WA, Miller MJ, et al.: Maturation of respiratory reflex responses in the piglet. J Appl Physiol 1991, 70:608–616.
- Kiatchoosakun P, Dreshaj IA, Abu-Shaweesh JM, et al.: Effects of hypoxia on respiratory neural output and lower esophageal sphincter pressure in piglets. Pediatr Res 2002, 52:50–55. CrossRef
- Hibbs AM, Lorch SA: Metoclopramide for the treatment of gastroesophageal reflux disease in infants: a systematic review. Pediatrics 2006, 118:746–752. CrossRef
- Martin RJ, Hibbs AM: Diagnosing gastroesophageal reflux in preterm infants. Pediatrics 2006, 118:793–794. CrossRef
- Carroll AE, Garrison MM, Christakis DA: A systematic review of nonpharmacological and nonsurgical therapies for gastroesophageal reflux in infants. Arch Pediatr Adolesc Med 2002, 156:109–113.
- Craig WR, Hanlon-Dearman A, Sinclair C, et al.: Metoclopramide, thickened feedings, and positioning for gastro-oesophageal reflux in children under two years. Cochrane Database Syst Rev 2004, 4:CD003502.
- Wenzl TG, Silny J, Schenke S, et al.: Gastroesophageal reflux and respiratory phenomena in infants: status of the intraluminal impedance technique. J Pediatr Gastroenterol Nutr 1999, 28:423–428. CrossRef
- Infant apnea and gastroesophageal reflux: A critical review and framework for further investigation
Current Gastroenterology Reports
Volume 9, Issue 3 , pp 219-224
- Cover Date
- Print ISSN
- Online ISSN
- Current Science Inc.
- Additional Links