Gastroesophageal reflux-induced hypoxemia in infants with apparent life-threatening event(s)
C. C. See, L. J. Newman, S. Berezin, M. S. Glassman, M. S. Medow, A. J. Dozor and S. M. Schwarz
Department of Pediatrics, New York Medical College, Valhalla 10595.
To evaluate relationships between gastroesophageal reflux (GER) and the
development and onset of apparent life-threatening event(s) (ALTE), 16
infants presenting with ALTE and 6 control subjects manifesting clinical
GER alone were studied using prolonged, esophageal pH monitoring in
conjunction with simultaneous pulse oximetry and transthoracic impedance
pneumocardiography. Despite the absence of a clinical vomiting history in
14 of 16 patients with ALTE, the incidence of GER was similar in both
groups (patients with ALTE vs control subjects, 95% vs 100%). Significant
arterial oxygen desaturation (less than 90% for greater than 3 minutes) was
monitored during 60 episodes in 14 of 16 infants with ALTE, compared with
no episodes of reduced arterial oxygen saturation in control subjects.
Fifty-four of 60 of these desaturation events commenced within 3.9 +/- 0.4
minutes (mean +/- SD) of onset of a drop in esophageal pH to less than 4.0.
Linear regression analysis indicates a significant correlation between
duration of esophageal acidification and length of individual hypoxemic
episodes (r = .39). Pneumocardiograms were normal in all patients. These
data suggest that unsuspected GER is common in infants presenting with ALTE
and, in these patients, GER may be directly associated with reflex
hypoxemic episodes. Prolonged intraesophageal pH monitoring, performed
simultaneously with evaluation for apnea, should be considered in all
infants presenting with ALTE.
