Gastroesophageal reflux in premature infants and the incidence of apnea, desaturation, and bradycardia events

Background The diagnosis of gastroesophageal reflux in premature infants is often based on clinical symptoms, namely apnea, desaturation, and bradycardia. This may lead to overdiagnosis and overtreatment in the management of gastroesophageal reflux. Objective To determine the relationship between gastroesophageal reflux with apnea, desaturation, and bradycardia in premature infants. Methods This cross-sectional study was done in premature infants with post-menstrual age of 32-36 weeks who had a history of apnea, desaturation, or bradycardia and suspected of having reflux. The subjects had no history of using prokinetic drugs or gastric acid suppressants, were not using advanced respiratory support, and had no congenital abnormalities. Gastroesophageal reflux was assessed using multiple intraluminal impedance – pHmetry for 24 hours. Results From a total of 20 subjects, there were 3,882 reflux events over 24 hours. Of these, 331 reflux events (8.5%) reached the upper esophageal sphincter. Two subjects (10%) had a reflux index ≥ 10%, indicating a risk of developing reflux esophagitis. Reflux contents were mostly liquid (79.9%) and weak acid (84.6%). The proportion of high reflux accompanied by apnea and bradycardia was very small (0.3%). High reflux was not associated with desaturation. Conclusion In our study, reflux occured in all premature infants, but only 10% of them had risk of reflux esophagitis. There were no associations between reflux and apnea, desaturation, or bradycardia. Therefore, these symptoms should not be used as the basis to diagnose reflux, much less to justify prescribing proton pump inhibitor drugs.