Impedance-pH monitoring and conventional pH monitoring are complementary methods to detect association between gastroesophageal reflux and apnea-related symptoms in preterm infants and neonates

Shin, Moon Sam; Shim, Jeong Ok; Moon, Jin Soo; Kim, Han Suk; Ko, Jae Sung; Choi, Jung Hwan; Seo, Jeong Kee

doi:10.3109/14767058.2012.697944

Cited by 13 publications

(14 citation statements)

References 34 publications

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“…Previous results have shown that acid refluxes are present in infants, even in newborns, and suggest they are responsible for pathological consequences, including laryngitis (Cresi et al, 2013;Jadcherla et al, 2011;López-Alonso et al, 2006;Shin et al, 2012;Vermeylen et al, 2005). However, our results may not apply to reflux laryngitis secondary to weakly acid reflux, which are especially prominent in newborns.…”

Section: Reflux Laryngitis Modelcontrasting

confidence: 51%

Effects of reflux laryngitis on non-nutritive swallowing in newborn lambs

Brisebois¹,

Samson²,

Fortier³

et al. 2014

Respiratory Physiology & Neurobiology

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Reflux laryngitis in infants may be involved not only in laryngeal disorders, but also in disorders of cardiorespiratory control through its impact on laryngeal function. Our objective was to study the effect of reflux laryngitis on non-nutritive swallowing (NNS) and NNS-breathing coordination. Two groups of six newborn lambs, randomized into laryngitis and control groups, were surgically instrumented for recording states of alertness, swallowing and cardiorespiratory variables without sedation. A mild to moderate reflux laryngitis was induced in lambs from the experimental group. A significant decrease in the number of NNS bursts and apneas was observed in the laryngitis group in active sleep (p = 0.03).In addition, lower heart and respiratory rates, as well as prolonged apnea duration (p < 0.0001) were observed. No physiologically significant alterations in NNS-breathing coordination were observed in the laryngitis group. We conclude that a mild to moderate reflux laryngitis alters NNS burst frequency and autonomous control of cardiac activity and respiration in lambs. ABSTRACTReflux laryngitis in infants may be involved not only in laryngeal disorders, but also in disorders of cardiorespiratory control through its impact on laryngeal function. Our objective was to study the effect of reflux laryngitis on non-nutritive swallowing (NNS) and NNS-breathing coordination. Two groups of six newborn lambs, randomized into laryngitis and control groups, were surgically instrumented for recording states of alertness, swallowing and cardiorespiratory variables without sedation. A mild to moderate reflux laryngitis was induced in lambs from the experimental group. A significant decrease in the number of NNS bursts and apneas was observed in the laryngitis group in active sleep (p = 0.03).In addition, lower heart and respiratory rates, as well as prolonged apnea duration (p < 0.0001) were observed. No physiologically significant alterations in NNS-breathing coordination were observed in the laryngitis group. We conclude that a mild to moderate reflux laryngitis alters NNS burst frequency and autonomous control of cardiac activity and respiration in lambs.

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Section: Reflux Laryngitis Modelcontrasting

confidence: 51%

Effects of reflux laryngitis on non-nutritive swallowing in newborn lambs

Brisebois¹,

Samson²,

Fortier³

et al. 2014

Respiratory Physiology & Neurobiology

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“…pH-only events may depend on immature peristalsis of the esophagus, lower LES tone, and delayed gastric empting (thus, explaining their increased frequency among preterm infants compared with older children and adults) or to other factors such as reflux esophagitis, insignificant bolus size, or slow pH drift. 22,29 We speculate that: (1) infants with BPD might have impaired esophageal motility, decreased basal LES tone, and increased LES relaxations, as pointed out by others 5 ; and (2) patients with BPD could be more sensitive than infants without BPD to the autonomic nervous system responses triggered by pH-only events that result in clinical symptoms. The latter point could be explained by the hypothesis that the esophageal afferent neural pathways might be more reactive to decreases in pH among patients with BPD because of their increased inflammatory state.…”

Section: Discussionmentioning

confidence: 90%

“…Proper location of the probe was identified as 2-3 cm above the left diaphragm. [20][21][22] The pH-MII probe was securely taped and connected to the Ohmega system; constant observation and review of the position at the end of the study were assured. pH-MII data were evaluated using manufacturer's software, and each tracing was manually reviewed and validated by the same operator (S.N.…”

Section: Ph-mii Methodsmentioning

confidence: 99%

Are Infants with Bronchopulmonary Dysplasia Prone to Gastroesophageal Reflux? A Prospective Observational Study with Esophageal pH-Impedance Monitoring

Nobile¹,

Noviello²,

Cobellis³

et al. 2015

The Journal of Pediatrics

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“…The proportion of nonacid reflux episodes relative to the total number varies from 45% to 90% in infants and children [7,13,14,15,16]. Nonacid reflux is especially prevalent in infants because of pH buffering associated with frequent milk intake.…”

Section: Significance Of Nonacid Refluxmentioning

confidence: 99%

“…It was developed to evaluate the movement of fluid, solid, and air in the esophagus regardless of its pH [5]. Combined multichannel intraluminal impedance-pH (MII-pH) monitoring has been used for the detection of reflux in children since 2002 [6,7,8]. …”

Section: Introductionmentioning

confidence: 99%

Esophageal pH and Combined Impedance-pH Monitoring in Children

Shin

2014

Pediatr Gastroenterol Hepatol Nutr

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Esophageal pH monitoring is considered the gold standard for the diagnosis of gastroesophageal reflux disease because of the normal ranges across the pediatric age range. However, this method can only detect acid reflux. Multichannel intraluminal impedance-pH (MII-pH) monitoring has recently been used for the detection of bolus reflux in infants and children. This method allows for the detection of liquid, gas or mixed reflux in addition to acid, weakly acidic or weakly alkaline reflux. MII-pH monitoring can record the direction of flow and the height of reflux, which are useful parameters to identify an association between symptoms and reflux. However, the technique is limited by its high cost and the lack of normative data of MII-pH in the pediatric population. Despite certain limitations, MII-pH monitoring will become more common and gradually replace pH monitoring in the future, because pH monitoring is part of MII-pH.

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Impedance-pH monitoring and conventional pH monitoring are complementary methods to detect association between gastroesophageal reflux and apnea-related symptoms in preterm infants and neonates

Abstract: Addition of MII-pH monitoring to conventional pH monitoring improves the diagnostic yield of symptom association analysis in preterm infants and neonates with apnea-related symptoms. Conventional pH monitoring is still important in the era of impedance measurement.

Cited by 13 publications

References 34 publications

Effects of reflux laryngitis on non-nutritive swallowing in newborn lambs

Effects of reflux laryngitis on non-nutritive swallowing in newborn lambs

Are Infants with Bronchopulmonary Dysplasia Prone to Gastroesophageal Reflux? A Prospective Observational Study with Esophageal pH-Impedance Monitoring

Esophageal pH and Combined Impedance-pH Monitoring in Children

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