Association of apnea and nonacid gastroesophageal reflux in infants: Investigations with the intraluminal impedance technique

Wenzl, Tobias G.; Schenke, Simone; Peschgens, T.; Silny, Jiri; Heimann, G.; Skopnik, H.

doi:10.1002/1099-0496(200102)31:2<144::aid-ppul1023>3.0.co;2-z

Cited by 192 publications

(146 citation statements)

References 37 publications

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“…101 Respiratory symptoms are more likely to be associated with GER when gross emesis occurs at the time of a BRUE, when episodes occur while the infant is awake and supine (sometimes referred to as "awake apnea"), and when a pattern of obstructive apnea is observed while the infant is making respiratory efforts without effective air movement. 102 Wenzl et al 103 reported a temporal association between 30% of the nonpathologic, short episodes of central apnea and GER by analyzing combined data from simultaneous esophageal and cardiorespiratory monitoring. These findings cannot be extrapolated to pathologic infant apnea and may represent a normal protective cessation of breathing during regurgitation.…”

Section: B Clinicians Should Not Prescribe Acid Suppression Therapymentioning

confidence: 99%

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Tieder¹,

Bonkowsky²,

Etzel³

et al. 2016

Pediatrics

141

154

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This is the fi rst clinical practice guideline from the American Academy of Pediatrics that specifi cally applies to patients who have experienced an apparent life-threatening event (ALTE). This clinical practice guideline has 3 objectives. First, it recommends the replacement of the term ALTE with a new term, brief resolved unexplained event (BRUE). Second, it provides an approach to patient evaluation that is based on the risk that the infant will have a repeat event or has a serious underlying disorder. Finally, it provides management recommendations, or key action statements, for lower-risk infants. The term BRUE is defi ned as an event occurring in an infant younger than 1 year when the observer reports a sudden, brief, and now resolved episode of ≥1 of the following: (1) cyanosis or pallor; (2) absent, decreased, or irregular breathing; (3) marked change in tone (hyper-or hypotonia); and (4) altered level of responsiveness. A BRUE is diagnosed only when there is no explanation for a qualifying event after conducting an appropriate history and physical examination. By using this defi nition and framework, infants younger than 1 year who present with a BRUE are categorized either as (1) a lower-risk patient on the basis of history and physical examination for whom evidence-based recommendations for evaluation and management are offered or (2) a higher-risk patient whose history and physical examination suggest the need for further investigation and treatment but for whom recommendations are not offered. This clinical practice guideline is intended to foster a patient-and family-centered approach to care, reduce unnecessary and costly medical interventions, improve patient outcomes, support implementation, and provide direction for future research. Each key action statement indicates a level of evidence, the benefi t-harm relationship, and the strength of recommendation.

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Section: B Clinicians Should Not Prescribe Acid Suppression Therapymentioning

confidence: 99%

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Tieder¹,

Bonkowsky²,

Etzel³

et al. 2016

Pediatrics

141

154

View full text Add to dashboard Cite

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“…The pH value of reflux episodes is important especially in infants 9 . In previous studies, a stronger association has been found between non-acid reflux episodes and respiratory symptoms in children with chronic respiratory disease 32,33 . In a recent study, the authors observed a higher prevalence of weakly acid reflux in infancy 34 .…”

Section: Discussionmentioning

confidence: 82%

Detection of gastroesophageal reflux in children with cerebral palsy using combined multichannel intraluminal impedance-ph procedure

et al. 2016

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Gastroesophageal reflux (GER) is a very common condition in children with neurological impairment and this can influence nutritional and respiratory outcomes. The aim of this study was to investigate the presence of GER in children with cerebral palsy (CP) using multiple intraluminal impedance (MII)-pH monitoring. The use of combined MII-pH allows for the detection of both acid and non-acid reflux episodes. A total of 29 CP patients with symptoms suggesting GER, aged 2 to 10 years old, underwent 24-hour combined MII-pH monitoring. There were a total of 3899 reflux episodes, of which 29% were acid, 60% were weakly acid and 11% were alkaline. The number of non-acid reflux episodes was statistically significantly greater (p<0.01). These findings confirm that GER disease is seen frequently in children with cerebral palsy and most of the reflux episodes are not acidic. Non-acid reflux can also influence the morbidity in patients with cerebral palsy. It can be concluded that 70% of the reflux episodes would not have been recognized by pH measurement alone.

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“…Actualmente la mayoría de los autores sugieren que para comprobar una relación con ALTE deberían realizarse estudios que demuestren una relación temporal entre ALTE y RGE, es decir una polisomnografía más Ph metría, que lamentablemente no esta disponible en la mayoría de los hospitales terciarios de nuestro país 16 . Wenzel demostró claramente una correlación entre la apnea y el RGE 17 . Mousa evidenció una relación temporal en el 15% de los episodios de apnea observados, no influyendo el grado de acidez 18 .…”

Section: Discussionunclassified

Causas atribuidas a eventos de aparente amenaza a la vida del lactante

Zenteno¹,

Z²,

et al. 2008

Rev. chil. pediatr.

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Causes attributed to apparent life-threatening event: 3 years of experienceBackground: An Apparent Life-Threatening Event (ALTE) is an important challenge for the pediatrician, which requires guidelines for finding the etiology and making appropriate clinical decisions. Objective: To describe etiologies and clinical features of ALTE in infants, as determined by a standarized protocol. Methods: A prospective study including infants admitted to the Emergency Room and hospitalized due to an ALTE between May 2002 and May 2005. They were evaluated with an established protocol that considers the episode description, clinical history, and complementary laboratory studies. Results: 109 patients with ALTE and a mean age of 11 weeks had the following symptoms: apnea (100%), skin color changes (97%), and muscle tone changes (83%). 96% received CPR maneuvers or strong stimulation maneuvers for ending the episode. Fourteen percent of the cases were idiopathic, while other etiologies included respiratory infections (46%), gastroesophageal reflux (16%), seizures (6%), and urinary tract infections (6%). 3 patients expired. Conclusions: With this protocol, based on tools available in most public tertiary hospitals in Chile, we can identify the causes of ALTE similar to those reported in other studies, howeber with a lesser percentage of idiopathic episodes.

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Association of apnea and nonacid gastroesophageal reflux in infants: Investigations with the intraluminal impedance technique

Cited by 192 publications

References 37 publications

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Brief Resolved Unexplained Events (Formerly Apparent Life-Threatening Events) and Evaluation of Lower-Risk Infants

Detection of gastroesophageal reflux in children with cerebral palsy using combined multichannel intraluminal impedance-ph procedure

Causas atribuidas a eventos de aparente amenaza a la vida del lactante

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