Combined Disturbance of Respiratory Regulation and Esophageal Function in Early Infancy

Kurz, Ronald; Höllwarth, M.; Fasching, Mario; Haidmayer, R; Pfeiffer, Karl P.; Kenner, Thomas

doi:10.1007/978-3-642-70276-1_7

Cited by 10 publications

(4 citation statements)

References 18 publications

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“…8,9 Infants are likely more susceptible to these problems due to possible disturbances of both esophageal function and respiratory regulation at this stage of life. 10 The "diving seal reflex," is a well known reflex involving the laryngeal chemoreceptors in aquatic mammals. Some of these pathways may still be present in human infants as well.…”

Section: Discussionmentioning

confidence: 99%

Neonatal Apnea Casebook

Sindel

Winkubourne

1999

J Perinatol

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CASE REPORT Baby girl "R" was born by breech vaginal delivery at 26 weeks' gestation. Birth weight was 1200 gm. The baby was floppy at birth and required cardiopulmonary resuscitation. Apgars were 1, 4, 5, and 7 at 1, 5, 10, and 15 minutes, respectively. The baby was transferred to the neonatal intensive care unit (NICU) where umbilical catheters were placed. She was placed on mechanical ventilation. Problems in the NICU included: (1) respiratory distress syndrome, treated with beractant (Survanta; Ross Pharmaceuticals, Columbus, OH) ϫ 2 and high frequency oscillatory ventilation; (2) right pneumothorax; (3) hypoglycemia; (4) metabolic acidosis; (5) nosocomial infection with Staphylococcal aureus; (6) anemia, treated with transfusion and Epogen; (7) apnea and bradycardia, treated with Aminophylline, which was discontinued after 56 days of age as the apnea and bradycardia seem to improve; (8) persisting oxygen requirement; and (9) retinopathy of prematurity, grade II in zone II, which subsequently resolved spontaneously. An auditory brainstem response (ABR) was performed at 73 days of age and was normal. Due to chronic lung disease, persisting oxygen requirement with occasional desaturation episodes and a previous history of apnea, a polysomnographic evaluation was performed at 74 days of age.

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Section: Discussionmentioning

confidence: 99%

Neonatal Apnea Casebook

Sindel

Winkubourne

1999

J Perinatol

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“…46 Moreover, the tendency to develop apnea and disturbed esophageal function are related to the degree of maturity of the patient, indicating that in some infants, a combined regulatory immaturity of the autonomic centers may persist. 47 However, it has been reported that in instances when apnea and reflux were related, the predominant sequence of events was obstructive apnea and to a lesser extent mixed apnea followed by reflux. 48 These results suggest that episodes of apnea may, at least in part, play a causative role in the development of GERD.…”

Section: Apnea and Gerd In Infantsmentioning

confidence: 99%

“…In fact, decreases in pH in the lower esophagus usually induce neither central nor obstructive apnea 46 . Moreover, the tendency to develop apnea and disturbed esophageal function are related to the degree of maturity of the patient, indicating that in some infants, a combined regulatory immaturity of the autonomic centers may persist 47 . However, it has been reported that in instances when apnea and reflux were related, the predominant sequence of events was obstructive apnea and to a lesser extent mixed apnea followed by reflux 48 .…”

Section: Apnea and Gerd In Infantsmentioning

confidence: 99%

Is There a Specific Linkage Between Obstructive Sleep Apnea Syndrome and Gastroesophageal Reflux Disease?

Mizuta¹,

Takeshima

Shikuwa

et al. 2006

Digestive Endoscopy

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Obstructive sleep apnea syndrome (OSAS) is a common condition characterized by repetitive sleep-induced collapse of the upper airways. It is associated with increased risk for hypertension, ischemic heart disease, cerebral stroke, and traffic accidents. In contrast, gastroesophageal reflux disease (GERD) is a very common disorder defined as various symptoms or esophageal mucosal damage generated by the abnormal reflux of gastric contents into the esophagus. Patients with OSAS have been reported to have a high prevalence of gastroesophageal reflux (GER) symptoms. The increase of transdiaphragmatic pressure in parallel with the large negative intrathoracic pressure produced during apnea events may directly lead to GER. In addition, some studies have demonstrated improvement in GERD with the application of continuous positive airway pressure, most consistently effective treatment for OSAS. However, GER dose not occur with every apnea. Moreover, the common conditions observed in patients with OSAS, including obesity or alcohol ingestion, are also predisposing factors for GER. A more recent investigation in over 1000 subjects failed to show a causal link between both diseases. Thus, the potential relationship between OSAS and GERD remains controversial. Inconsistencies in definitions of both diseases or sampling biases may contribute to the confusing results.

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“…Das gehäufte Auftreten des GÖR bei solchen Risikokindern einerseits sowie die enge anatomische Nachbarschaft der Zentren für Schluck-und Atemfunktion in der Medulla oblongata andererseits gaben Anlaß, Apnoeneigung und gestörte Speiseröhrenmotorik als kombinierte Regulationsunreife zu betrachten (20,23,27,31,46). Downing Die Untersuchung zeigt, daß Säuglinge mit periodischen Apnoen und/oder Cyanose im Schlaf ein pathologisches Atemmuster mit längeren Apnoephasen aufweisen und sich in dieser Hinsicht nicht von Säuglingen mit einem near miss Ereignis in der Anamnese unterscheiden.…”

Section: Diskussionunclassified

Speiseröhrenfunktion von Säuglingen mit Sudden Infant Death - Risiko

Landler¹,

Höllwarth²,

Uray³

et al. 1990

Klin Padiatr

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In 24 patients at risk for SIDS (12 infants with a near miss event and 12 infants with apnea and perioral cyanosis during sleep) respiratory and esophageal function were investigated by impedance pneumography (IP) and esophageal manometry combined with simultaneous pH-monitoring (EMPH). Both groups had ad early pathologic breathing pattern, but did not show any difference in the recorded parameters (number of apneic spells, longest apneic spell, apneic spells longer than 10 seconds, transcutaneous oxygen pressure, mean apnea time). Near miss infants had about 50% more manometric refluxes (15.4 +/- 1.3) than the apnea/cyanosis group (9.9 +/- 2.2). This difference was mainly caused by a significant rise of reflux episodes without pH-change (near miss 8.5 +/- 3.1 versus 2.9 +/- 1.4 in apnea/cyanosis infants). Furthermore, propulsive peristaltic properties after induced swallows were more disturbed in the near miss group (3.3 +/- 1.0 versus 6.1 +/- 1.9). On the other hand, the apnea cyanosis group showed significantly more pH-drops under 4 (6.8 +/- 2.3 vs 2.4 +/- 0.7), which might be due to a more rapid clearance of neutralising milk from the stomach in these infants. In conclusion the study showed that infants with a near miss event in the anamnesis suffer from a more pathologic esophageal motor function when compared with infants with apneic spells and cyanosis during sleep. Near miss infants are also considered to have a delay of gastric clearance.

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Combined Disturbance of Respiratory Regulation and Esophageal Function in Early Infancy

Cited by 10 publications

References 18 publications

Neonatal Apnea Casebook

Neonatal Apnea Casebook

Is There a Specific Linkage Between Obstructive Sleep Apnea Syndrome and Gastroesophageal Reflux Disease?

Speiseröhrenfunktion von Säuglingen mit Sudden Infant Death - Risiko

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