Correlation between cardiorespiratory events and gastro-esophageal reflux in preterm and term infants: Analysis of predisposing factors

S Nobile; P Marchionni; C Noviello; V P Carnielli

doi:10.1016/j.earlhumdev.2019.05.003

Correlation between cardiorespiratory events and gastro-esophageal reflux in preterm and term infants: Analysis of predisposing factors

Early Hum Dev. 2019 Jul:134:14-18. doi: 10.1016/j.earlhumdev.2019.05.003. Epub 2019 May 18.

Authors

S Nobile¹, P Marchionni², C Noviello³, V P Carnielli³

Affiliations

¹ Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy; Department of Woman and Child Health and Public Health, Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: stefano.nobile@ospedaliriuniti.marche.it.
² Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Ancona, Italy.
³ Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy.

PMID: 31112857
DOI: 10.1016/j.earlhumdev.2019.05.003

Abstract

Background: The association between cardiorespiratory events (CRE) and gastro-esophageal reflux (GER) among neonates is still controversial.

Aims: To test such an association in preterm and term infants.

Study design: Prospective observational study.

Subjects: Forty-seven infants with suspected GER and recurrent CRE admitted at a neonatal intensive care unit, who underwent simultaneous and synchronized 24-hour recording of heart rate (HR), peripheral oxygen saturation (SpO2) and pH-impedance monitoring (MII-pH). HR/SpO2 data were filtered to avoid artefactual episodes of hypoxia and hypoperfusion.

Outcome measures: The main outcome measure was the symptom association probability (SAP), with a 2-minute time window. Infants with positive (>95%) and negative (≤95%) SAP index tests were compared by univariate and multivariate statistics.

Results: Median gestational age at birth was 29^4/7 weeks, median age at study 36 days. We recorded 3341 GER events and 4936 CRE (4710 desaturations, 226 bradycardias); 609/4936 (12%) CRE were temporally associated with GER episodes: 338 preceded and 271 followed GER events. The SAP index was significant in 5/47 (11%) patients. The SAP index including only CRE following GER events was significant in 3/47 (6%). There was no significant difference in the number of acid, weakly acid, non-acid, pH-only events preceding or following CRE between infants with SAP-positive and SAP-negative tests. Infants with positive SAP-index tests compared to those with SAP-negative tests had lower weight gain in the three days preceding the test and tended to have lower birth weight.

Conclusions: GER and CRE were associated in <11% of patients. The evaluation of ponderal growth might be helpful in predicting such an association.

Keywords: Apnea; Bradycardia; Esophageal pH monitoring; Gastro-esophageal reflux; Infant; Multichannel intraluminal impedance.

Publication types

Observational Study

MeSH terms

Apnea / epidemiology*
Bradycardia / epidemiology*
Female
Gastroesophageal Reflux / epidemiology*
Heart Rate
Humans
Infant, Newborn
Infant, Premature / physiology*
Male
Oxygen Consumption