Gastroesophageal Reflux Disease and Sudden Infant Death: Mechanisms behind an Under-Recognized Association

Al-Adnani, Mudher; Cohen, Marta C.; Scheimberg, Irene

doi:10.2350/09-11-0748-cr.1

Cited by 7 publications

(6 citation statements)

References 16 publications

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“…We believe that esophageal peristalsis helps in the clearance of the noxious stimulus, and EPSR may prevent SER. Studies suggest that acid reflux of gastric contents causes apnea in animals or human infants (45), and GER is associated with SIDS (1,35,45). In addition, it has been found that sleep is associated with decreased swallowing and longer esophageal acid clearance time (33).…”

Section: Discussionmentioning

confidence: 99%

Characterization and mechanisms of the pharyngeal swallow activated by stimulation of the esophagus

Lang

Medda

Jadcherla

et al. 2016

American Journal of Physiology-Gastrointestinal and Liver Physi

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Stimulation of the esophagus activates the pharyngeal swallow response (EPSR) in human infants and animals. The aims of this study were to characterize the stimulus and response of the EPSR and to determine the function and mechanisms generating the EPSR. Studies were conducted in 46 decerebrate cats in which pharyngeal, laryngeal, and esophageal motility was monitored using EMG, strain gauges, or manometry. The esophagus was stimulated by balloon distension or luminal fluid infusion. We found that esophageal distension increased the chance of occurrence of the EPSR, but the delay was variable. The chance of occurrence of the EPSR was related to the position, magnitude, and length of the stimulus in the esophagus. The most effective stimulus was long, strong, and situated in the cervical esophagus. Acidification of the esophagus activated pharyngeal swallows and sensitized the receptors that activate the EPSR. The EPSR was blocked by local anesthesia applied to the esophageal lumen, and electrical stimulation of the recurrent laryngeal nerve caudal to the cricoid cartilage (RLNc) activated the pharyngeal swallow response. We conclude that the EPSR is activated in a probabilistic manner. The receptors mediating the EPSR are probably mucosal slowly adapting tension receptors. The sensory neural pathway includes the RLNc and superior laryngeal nerve. We hypothesize that, because the EPSR is observed in human infants and animals, but not human adults, activation of EPSR is related to the elevated position of the larynx. In this situation, the EPSR occurs rather than secondary peristalsis to prevent supraesophageal reflux when the esophageal bolus is in the proximal esophagus.

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Section: Discussionmentioning

confidence: 99%

Characterization and mechanisms of the pharyngeal swallow activated by stimulation of the esophagus

Lang

Medda

Jadcherla

et al. 2016

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…35,52 Similarly, immaturity of vagal irritant reflexes has been implicated as a cause for silent aspiration and apnoea in infants born preterm. 71,72 It has been proposed that laryngeal chemoreflex may play a role in some cases of SIDS 35,52 ; 14% of SIDS cases have evidence of aspiration. 70 Gastro-oesophageal reflux is common in the first months of postnatal life, peaking at 3 to 4 months.…”

Section: The Hippocampus Seizures and Apnoeamentioning

confidence: 99%

“…2 Gastro-oesophageal reflux is also associated with sudden death. 71,72 It has been proposed that laryngeal chemoreflex may play a role in some cases of SIDS 35,52 ; 14% of SIDS cases have evidence of aspiration. 73…”

Section: Sensory Afferents From the Upper Airway: Oxygenconserving Rementioning

confidence: 99%

Infants dying suddenly and unexpectedly share demographic features with infants who die with retinal and dural bleeding: a review of neural mechanisms

Squier

Mack

Jansen

2016

Develop Med Child Neuro

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The cause of death in infants who die suddenly and unexpectedly (sudden unexpected death in infancy [SUDI]) remains a diagnostic challenge. Some infants have identified diseases (explained SUDI); those without explanation are called sudden infant death syndrome (SIDS). Demographic data indicate subgroups among SUDI and SIDS cases, such as unsafe sleeping and apparent life-threatening events. Infants dying suddenly with retinal and dural bleeding are often classified as abused, but in many there is no evidence of trauma. Demographic features suggest that they may represent a further subgroup of SUDI. This review examines the neuropathological hypotheses to explain SIDS and highlights the interaction of infant oxygen-conserving reflexes with the brainstem networks considered responsible for SIDS. We consider sex- and age-specific vulnerabilities related to dural bleeding and how sensitization of the dural innervation by bleeding may influence these reflexes, potentially leading to collapse or even death after otherwise trivial insults.

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“…This spontaneous aspiration caused by gastroesophageal reflux, including steps of relaxation of esophageal sphincters, suppression of upper airway protective reflexes, and terminal inspiratory efforts, occurs even among non-resuscitated corpses as a terminal event [ 27 ]. Terminal gasping and autoresuscitation are thought to generate aspiration from the gastroesophageal route [ 14 , 28 , 29 ]. It is noteworthy that the presence of gastric contents in the airway does not invariably imply the occurrence of antemortem fatal aspiration [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

Gastric aspiration in sudden unexpected infant death of Prader–Willi syndrome: immunohistochemical detection of feeding components

et al. 2022

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Prader–Willi syndrome (PWS) in infants is characterized by hypotonia and poor sucking with feeding difficulties. Two autopsy cases of sudden unexpected death during sleep after tube feeding are described herein. For one, gastric aspiration caused by the possible milk regurgitation was suspected. Immunohistochemical examination of lung sections was performed using three antibodies to human α-lactalbumin, human gross cystic disease fluid protein 15, and cow whey β-lactoglobulin. Five cases of sudden unexpected infant death occurring earlier than at 6 months old were selected as controls. Marked immune-staining for infant formula in one PWS subject was evident within terminal bronchioles and alveoli with granular and amorphous features. However, no positive staining was apparent in the other subject, who exhibited contrasting features in milk distribution. Among control cases, one showed mild staining in the bronchiole, but the others did not. The antibody to β-lactoglobulin reacted specifically with formula, with no nonspecific background. Gastric contents in the airway can be a difficult issue because of the consequent terminal gasping. However, because of an episode of antemortem symptoms of potential regurgitation, and from findings at autopsy such as petechiae, we inferred that fatal regurgitation occurred in this PWS infant after tube feeding. Several clinical reports have described milk aspiration, but this pathological report is the first related to aspiration in PWS during tube feeding.

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Gastroesophageal Reflux Disease and Sudden Infant Death: Mechanisms behind an Under-Recognized Association

Cited by 7 publications

References 16 publications

Characterization and mechanisms of the pharyngeal swallow activated by stimulation of the esophagus

Characterization and mechanisms of the pharyngeal swallow activated by stimulation of the esophagus

Infants dying suddenly and unexpectedly share demographic features with infants who die with retinal and dural bleeding: a review of neural mechanisms

Gastric aspiration in sudden unexpected infant death of Prader–Willi syndrome: immunohistochemical detection of feeding components

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