Cardiorespiratory events in infants with gastroesophageal reflux symptoms: Is there any association?

Cresi, Francesco; Martinelli, Domenico; Maggiora, Elena; Locatelli, Emanuela; Liguori, Stefania Alfonsina; Martire, Baldassarre; Cocchi, Enrico; Bertino, Enrico; Coscia, Alessandra

doi:10.1111/nmo.13278

Cited by 23 publications

(19 citation statements)

References 41 publications

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“…9 Nevertheless, in the latest decade, MII/pH data has led to improvements in our knowledge of GER pathophysiology and has helped assess the relationship between GER events and symptoms. [10][11][12][13] MII/pH can detect all types of GER events, and these events can be classified according to concomitant changes in the intra-esophageal pH. 7,14 Furthermore, MII/pH allows us to analyze the relationship between GER events and symptoms through methods such as the symptom index (SI), symptom sensitivity index, and symptom association probability (SAP) index.…”

Section: Introductionmentioning

confidence: 99%

Multichannel Intraluminal Impedance and pH Monitoring: A Step Towards Pediatric Reference Values

Cresi

Cester

Salvatore

et al. 2020

J Neurogastroenterol Motil

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Background/Aims Combined multichannel intraluminal impedance and pH monitoring (MII/pH) is considered the most accurate test to detect gastroesophageal reflux (GER), however lacking reference values. We aim to determine reference values for the pediatric population and to correlate these values with age and postprandial/fasting period. Methods We evaluated MII/pH traces from patients (newborns, infants, and children) admitted to 3 Italian hospitals and who underwent MII/ pH for suspected GER disease. Patients with MII/pH traces that showed significant symptom-reflux associations and/or a pathological reflux index (> 6% for newborns and infants, > 3% for children) were excluded. Traces were analysed in their entirety, and in the postprandial period (first hour after a meal) and the fasting period (the following hours before the next meal) separately. Results A total of 195 patients (46 newborns, 83 infants, and 66 children) were included. Age positively correlated with frequency of acidic GER events (r = 0.37, P < 0.05) and negatively associated with weakly acidic GER events (r = 0.46, P < 0.05). Conclusions This study describes the distribution of MII/pH values in a pediatric population with normally acidic GER exposure and no significant association between GER events and symptoms. These MII/pH values may be used as reference values in clinical practice for a corrected GER disease diagnosis in the pediatric population.

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Section: Introductionmentioning

confidence: 99%

Multichannel Intraluminal Impedance and pH Monitoring: A Step Towards Pediatric Reference Values

Cresi

Cester

Salvatore

et al. 2020

J Neurogastroenterol Motil

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“…In Australia and the United States, almost half of all board-certi ed neonatologists believe that apnea is caused by GERD and are likely to recommend acid suppressors (14,15). Cresi et al found the associations of GER and cardiorespiratory events such as apnea existed in 12% of infants and most of them were caused by non-acidic re ux events (6). But some studies speculated that there is no relationship between apnea and GER in preterm infants (16,17).…”

Section: Discussionmentioning

confidence: 99%

“…The inclusion criteria were gestational age (GA) ≤ 32 weeks and clinical symptoms indicative of GER (including apnea, cyanosis, recurrent vomiting, aspiration pneumonia, poor weight gain) according to the criteria of the North American Society for Pediatric Gastroenterology and Nutrition (5). Apnea was de ned as breathing pauses lasting for more than 20 s, or for more than 10 s together with bradycardia or oxygen desaturation (6). Cyanosis was judged by blood oxygen desaturation below 80%.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and Risk Factors for Gastroesophageal Reflux in Symptomatic Very Preterm Neonates

Hu¹,

Fu²,

Zhang³

2020

Preprint

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Background Because of immature development, preterm infants are prone to respiratory and digestive symptoms of dyspnea, vomiting, and aspiration pneumonia. These symptoms are often observed in infants with gastroesophageal reflux (GER). However, the relationship between GER and these symptoms remain unclear.Methods A cohort of 61 preterm infants born at 32 weeks of gestation or earlier with respiratory or digestive symptoms were retrospectively reviewed. All the preterm infants underwent 24-hour pH-multichannel intraluminal impedance monitoring. Clinical data were analyzed using logistic regression analyses.Results Among the 61 symptomatic preterm infants, 34 were positive for pathologic GER with a prevalence of 55.7%. The GER associated symptoms included apnea (42.6%), cyanosis (19.7%), vomiting (14.8%), pneumonia (9.8%), and poor weight gain (13.1%). These respiratory and digestive symptoms were more frequent in infants with pathologic GER than in those without. (p<0.05) The risk factors for GER included severe BPD (odds ratio [OR], 6.890; 95% confidence interval [CI], 1.125-42.209). Probiotics and delayed full oral feeds reduced the risk of GER (odds ratio [OR], 0.642; 95% confidence interval [CI], 0.457-0.901, p<0.05; OR, 0.234, 95% CI, 0.069-0.794, p<0.05). Conclusions The prevalence of GER is high in the symptomatic preterm infants. GER aggravates the respiratory and digestive symptoms holding that not all the symptoms are GER associated. Probiotics and delayed full oral feeds can decrease the prevalence of GER.

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“…CR events were defined as episodes of apnoea lasting more than 20 seconds or over 5 seconds if followed by desaturation or bradycardia, episodes of desaturation with blood oxygen saturation below 80%, and episodes of bradycardia with heart rate below 80 beats per minute. (7,19) Minimum duration of bradycardia and blood oxygen desaturation events to be considered for the analysis was 4 seconds.…”

Section: Cr Monitoringmentioning

confidence: 99%

“…The GER events involved in these associations are mainly weakly acidic suggesting that the empirical treatment with antacids is, in most of these cases, inappropriate. (4,7) The proper approach to the problem of GER in preterm infants should be aimed at improving feeding tolerance by adopting techniques and behaviors involving nutrition strategies (thickening of feeds, positioning, slow feeding) and able to reduce the frequency of refluxes. Among these strategies the choice of the most proper nutrition can also influence GER.…”

Section: Introductionmentioning

confidence: 99%

Effects on gastroesophageal reflux of donkey milk-derived human milk fortifier versus standard fortifier in preterm newborns. Additional data from Fortilat study.

Cresi

Maggiora

Pirra

et al. 2020

Preprint

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Background : Feeding intolerance, defined as the inability to digest enteral feeding, is a frequent diagnosis in very preterm infants. It is characterized by abdominal distension, delayed gastric emptying and increased frequency and severity of gastroesophageal reflux (GER). As seen in the FortiLat trial, human milk fortification with the new donkey milk-derived human milk fortifier (DF) seems to improve feeding tolerance in these infants. The aim of this ancillary study of the FortiLat trial was to evaluate the effects of using the DF compared with bovine milk-derived fortifier (BF) on GER in VLBW infants.Methods : Over a total of 156 preterm infants enrolled into the FortiLat trial (gestational age <32 weeks and/or birth weight <1500 g) and randomized into BF-arm or DF-arm we selected all infants with clinical signs of GER and cardiorespiratory (CR) symptoms at day 21 of fortification. All the infants underwent CR and multichannel intraluminal impedance and pH (MII/pH) monitoring associated with gastric ultrasound to evaluate GER characteristics, GER-CR temporal associations and gastric emptying time.Results : 10 infants were enrolled, 5 in the DF-arm. At MII/pH infants enrolled into the DF-arm showed a lower GER frequency than BF-arm infants: 2.02(1.95-3.26) vs 4.82(2.84-5.94) GER/hour (p=0.036). No infant had a significant symptom association probability index between GER and CR events. Half gastric emptying time was similar in DF and BF-arm infants: 45.03(42.74-47.02) vs. 48.57(44.73-48.77) min. (p=0.744)Conclusions : The use of donkey derived human milk fortifier reduced the GER frequency and consequently should be recommended in infants with feeding intolerance.Trial Registration : ISRCTN -ISRCTN70022881. Registered 01May 2014 - Retrospectively registered, http://www.isrctn.com/ISRCTN70022881

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Cardiorespiratory events in infants with gastroesophageal reflux symptoms: Is there any association?

Cited by 23 publications

References 41 publications

Multichannel Intraluminal Impedance and pH Monitoring: A Step Towards Pediatric Reference Values

Multichannel Intraluminal Impedance and pH Monitoring: A Step Towards Pediatric Reference Values

Prevalence and Risk Factors for Gastroesophageal Reflux in Symptomatic Very Preterm Neonates

Effects on gastroesophageal reflux of donkey milk-derived human milk fortifier versus standard fortifier in preterm newborns. Additional data from Fortilat study.

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