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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An understanding of gastroesophageal reflux disease in infants and children by the clinician requires a working knowledge of 18- to 24-hour esophageal pH monitoring and the motility disorders of the esophagus and stomach that may be associated with gastroesophageal reflux disease. The results of surgical therapy for childhood gastroesophageal reflux disease cannot be assessed accurately without this knowledge. Antireflux operations can be tailored to the child's situation, which includes a combination of clinical symptoms and findings on objective tests for reflux and associated alimentary-tract motility disorders. The presence of severe complications from gastroesophageal reflux disease in "asymptomatic" infants and children is a troublesome and not yet fully defined problem. Special areas include the documentation of gastroesophageal reflux disease as a cause of SIDS, the increased reporting of Barrett's esophagus and adenocarcinoma of the esophagus in childhood, and the effect of associated alimentary-tract motility disorders in children with CNS disease who have gastroesophageal reflux disease requiring surgical intervention.
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PMID:Current surgical considerations in gastroesophageal reflux disease in infancy and childhood. 144 Jan 62

The preceding discussion has consisted of a review of the technical and clinical aspects of pediatric multichannel recordings, which have become a widely used procedure in the clinical evaluation of infants with various apnea syndromes. It has been shown that multichannel recordings are superior to two-channel pneumocardiograms. Multichannel recordings should therefore be considered in all infants with unexplained episodes of apnea, bradycardia or cyanosis, in order to clarify the type of apnea and to rule out underlying conditions such as gastroesophageal reflux or seizures. The role of multichannel recording in predicting the risk of further apnea and SIDS, however, remains questionable. The clinical introduction of documented monitoring in the home setting with integrated pulse oximetry and a method for monitoring respiratory airflow might help to identify those infants at risk for apnea and SIDS in the future (see article by Weese-Mayer and Silvestri). Nevertheless, multichannel recordings in the hospital have provided a useful tool in the initial evaluation of many infants with infant apnea, and, for SIDS research, they have been useful for evaluating the complex autonomic control mechanisms during sleep and wakefulness.
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PMID:Multichannel polysomnographic recording for evaluation of infant apnea. 146 96

Eight infants with histories of apnea and cyanosis were referred to the Southwest SIDS Research Institute for evaluation of apparent life threatening events (ALTE). All of the infants had been treated for colic with a 1:1 concentration of dimenhydrinate (Dramamine) and phenobarbital, hyoscyamine sulfate, atropine sulfate and scopolamine hydrobromide (Donnatal). The medication was pre-mixed by local pharmacists. A comprehensive work-up failed to reveal a cause for the ALTE in any infant. The Dramamine/Donnatal mixture was withdrawn and polygraphic evaluation was conducted. Cardiorespiratory abnormalities were identified in all eight infants and significant gastroesophageal reflux (GER) was documented in four. The possibility that colic medication contributes to cardiorespiratory instability and GER in vulnerable infants requires serious consideration and further evaluation.
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PMID:Colic medication and apparent life-threatening events. 204 36

GER may be considered as one of the triggering factors in some apparently life-threatening events or even SIDS. Also at the present time, many teams perform 24-h pH monitoring in at-risk infants and treat those with abnormal scores. However, further investigations are needed to answer the question: Which unknown additional factor(s) is present when a specific episode of GER causes apnea and/or bradycardia either during sleep or wakefulness?
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PMID:Interference between gastroesophageal reflux and sleep in near miss SIDS. 209 67

We investigated brainstem auditory evoked potentials (BAEP) in 20 infants at risk of SIDS (age 5 days to 4 months) and in 7 control infants (age 5 days to 4 months). 19 infants were diagnosed as having sleep apnea syndrome (SAS), which we consider to be a possible risk factor for SIDS. The diagnosis of SAS was made in general in the presence of clinical symptoms such as apneas, cyanosis during sleep, poorly coordinated sucking, swallowing and respiration and gastro-oesophageal reflux in combination with an abnormal pneumogramm in a one hour oxycardiorespirography. One infant had the history of a near miss event but a normal pneumogramm, 2 infants, both with SAS, were siblings of SIDS infants. We applied BAEP on 12 infants at risk of SIDS with and on 12 infants at risk of SIDS without aminophyllin treatment. 3 infants at risk of SIDS had two BAEP studies, one before and one during aminophyllin treatment. The time interval between these two studies was 1 week to 16 days. Aminophyllin, given only to infants with SAS was administered orally (therapeutic range 4-10 micrograms/ml). All infants at risk of SIDS and all control infants had normal I-V-IPL (below 2 x SD). There was a tendency to longer I-V IPL in infants at risk of SIDS. When infants at risk of SIDS with and without aminophyllin treatment were compared as a group the I-V-IPL was shorter in the infants with aminophyllin. BAEP can be useful in studying disturbances of the autonomic function of brainstem centers but do not allow the prediction of an individual SIDS risk.
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PMID:[Acoustically evoked brain stem potentials in infants at risk for SIDS with and without aminophylline therapy]. 279 43

Pneumograms of 33 fullterm infants (age 1-16 weeks) with idiopathic sleep apnea syndrome (SAS), treated with aminophyllin administered orally, were compared with pneumograms of 12 age-matched infants without aminophyllin treatment. In a one hour oxycardiorespirography (OCRG) all infants had pneumogram abnormalities defined as apneas greater than or equal to 15 s, greater than or equal to 3 apneas lasting 10 s, MA-value (mean duration of all apneas during sleep time) greater than or equal to 7 s/min, and greater than or equal to 3 episodes of periodic breathing. The diagnosis of an SAS, discussed as a possible risk factor of SIDS, was made in general in the presence of clinical symptoms such as apneas, cyanosis during sleep, poorly coordinated sucking, swallowing and respiration, and gastro-esophageal reflux (GER) in combination with an abnormal pneumogram. Of the 33 infants 12 with a history of an SIDS sibling were clinically asymptomatic. We found that after one week of aminophyllin treatment in 88% the pneumograms were normal. The mean plasma concentration of aminophyllin at this time was 8.3 micrograms/ml (range 4-19 micrograms/ml). All abnormalities showed a statistically significant reduction. In the infants without aminophyllin the pneumogram was still abnormal and no abnormality was significantly reduced. After at least 6 weeks we discontinued aminophyllin and one week later we monitored the OCRG. In 83% of the infants we found a normal pneumogram and compared to the initial pneumogram there was again a statistically significant difference.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Effect of aminophylline therapy in mature infants with sleep apnea syndrome]. 321 Nov 67

Apneas in the different sleep states are commonly observed in the full-term healthy newborn infant. Central and short apneas prevail whilst apneas greater than 15 sec. are rare; a marked incidence of short apneas (less than 10 sec.) was observed in active sleep, even though apneas are not exclusive of active sleep. There is a strong inter-individual variability of apnea incidence. Apnea incidence in a state is not positively correlated to apnea incidence in different behavioural states: on the contrary there seems to be an opposite correlation between incidence in AS and QS. Apnea occurrence is positively correlated, in individuals, to the periodic breathing percentage. Apneas number and their duration is markedly lowered already in the second month of life. Periodic breathing must be considered a feature of immaturity. Obstructive apneas are less frequent than central apneas: their survey requires sophisticated technics with the aid of simultaneous recording of several breathing parameters. Relationship between central apneas/ obstructive apneas and mixed apneas is not known. Certainly obstructive and mixed apneas occurrence has been underestimated because of technical difficulties deriving from their survey. The meaning of an incidence of short apneas markedly higher than normal in full-term newborn infants is controversial and not clear, individuals with long apneas and subjects with short apneas in excess have been considered infants at SIDS risk. It is not clear whether periodic breathing and apneas depend on a common pathogenesis; the correlation between high incidence of periodic breathing in postnatal period and SIDS risk is still controversial. Few Authors suggest to treat newborn infants with extended apneas in sleep and considerable percentage of periodic breathing with aminophylline. The relation between gastro-oesophageal reflux and apnea has been recently evidenced. Central apneas and obstructive apneas during breast and bottle feeding have also been documented. Differently from pre-term infant apneas, bradycardia, although not exceptional, is not frequent during apneas in full-term newborn infants.
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PMID:[Apnea during sleep and wakefulness in term newborns]. 360 11

The authors recall some hypothesis about factors of risk which are acknowledged as possible element of SIDS and may receive a treatment: gastroesophageal reflux, vagal hyperexcitability and enzymatic deficit.
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PMID:[Medical behavior and sudden infant death]. 362 May 83

The examination of the respiratory function in 184 sleeping infants gave evidence of a significant difference in several parameters between the so-called SIDS risk group and the control group. The risk group (97 babies) consists of 60 infants with frequent prolonged apneas, 30 infants with postnarcotic apneas and 7 near miss infants. Polygraphic registration during sleep showed significantly more apneas in the risk group. These apneas often appeared more frequently during certain periods. The average respiratory deficit expressed as the MA-value (MA = average apnea duration) in the risk group was significantly higher than in control infants. Besides that we were able to prove a more frequent pathological gastroesophageal reflux in the risk infants than in control infants.
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PMID:[Sleep apnea in infants and the risk of SIDS]. 395 42

Knowledge regarding the etiology and optimal management of prolonged apnea and its relationship to SIDS is still limited. The majority of infants with prolonged apnea do not die of SIDS, although the risk of SIDS in this group is greater than in the general population. Many infants with prolonged apnea who are perceived by parents and physicians as having had a "life-threatening" event may be at risk for another. Appropriate assessment following this event includes a careful history and physical examination to determine cause and severity. Etiologies to be considered include infections, metabolic aberrations, seizure problems, cardiac arrhythmias or congenital heart disease, anatomic airway abnormalities, gastroesophageal reflux and impaired regulation of breathing. If a specific cause has been identified for the infant's apnea, appropriate treatment often will lead to resolution of the apnea problem. If a specific etiology has not been identified or if the risk of "life-threatening" prolonged apnea seems to persist, electronic cardiorespiratory monitoring may be considered. Appropriate treatment for asymptomatic infants who are at increased statistical risk of SIDS is controversial. Asymptomatic infants may be candidates for home monitoring, but as yet, there are no reliable tests to predict which infants are at risk for prolonged apnea. Monitoring at home must be prescribed by the physician and should be continued until judged no longer appropriate by the attending physician. Skilled caregivers are crucial to the continuous observation and management of these patients in the hospital and at home. Therefore parents should be taught monitor use and also CPR.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Evaluation and management of infantile apnea. 670 8


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