Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Forty-five term infants who had a "near miss" for SIDS were studied with a continuous overnight polygraphic recording of endoesophageal pH, respiration, and ECG. Recordings were examined for occurrences of GER and for central apnea of 10 seconds or greater duration. There were 341 apneic events greater than or equal to 10 seconds recorded in 46 studies, with a mean of 7 +/- 7. In 91% of the infants, no apneas exceeded 15 seconds. Only 31 episodes of apnea greater than or equal to 10 seconds occurred during GER: in two of these episodes the apneic event was greater than or equal to 15 seconds. Twenty-four of the 31 apneas greater than or equal to 10 seconds during periods of pH less than 4 occurred in one infant. A total of 356 precipitous pH drops was recorded (mean 8.7 +/- 7.4). The pH drops occurred most frequently when the patient appeared to be awake (73%), and in 84% of events there was movement before and during the pH change. We conclude that the majority of these near miss SIDS infants had GER associated with movement during awake periods, without any temporal relationship to apnea. Although reflex apnea following GER may be seen in some term infants, this problem may be more significant for the immature infant.
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PMID:Movement and gastroesophageal reflux in awake term infants with "near miss" SIDS, unrelated to apnea. 708 88

Gastro-oesophageal reflux (GOR) has been identified as a possible cause of SIDS. Several features of GOR unique to infants presenting with apparent life-threatening events (ALTEs) have led to its 'pathogenic' definition. One is that the life-threatening apnoea itself is initiated by GOR, another is that the ALTE relates to prolonged reflux during sleep, in a vulnerable sleep-state, and finally that the ALTE relates to excessive quantities of GOR. The presumption of GOR 'pathology' as a cause of SIDS however, is questionable in these susceptible infants for three reasons: firstly, GOR is physiological and occurs in most infants; secondly, there is no general consensus on what constitutes normal physiological reflux, and thirdly, variation in the recording technique and methods of data analysis and interpretation may account for the differences between study groups. It seems likely therefore if GOR is implicated in SIDS, additional factors are involved. Under certain circumstances, physiological GOR may trigger life-threatening apnoea in apparently healthy infants, that leads to SIDS. One mechanism that could explain such a death is reflex apnoea by stimulation of laryngeal chemoreceptors (LCR) during sleep. The conditions under which this could be fatal are the occurrence of gastric contents refluxed to the level of the pharynx during sleep, in the young infant who has depressed swallowing and arousal. That is, the occurrence of GOR to the level of the pharynx during sleep, an infrequent event that is usually innocuous, could be converted to a fatal event if swallowing is impaired and arousal depressed, by a variety of mediating factors such as prone sleeping, prematurity, sedatives, seizures or upper respiratory tract infections. The identification of LCR responses, particularly in prone sleeping and premature infants provide further evidence that this mechanism may be implicated in the aetiology of SIDS in apparently healthy infants.
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PMID:The role of gastro-oesophageal reflux in the aetiology of SIDS. 1099 49

In order to determine parental reasons of the use of home apnea/respiration monitors and to estimate the grounds of these decisions correspondence contact was achieved with the parents of 71 infants monitored by means of the APNEAL-1 device. Filled up questionnaires were the source of data regarding the families (structure, health practices, mothers' age and education, course of pregnancy and delivery), monitored infants (birth weight, Apgar score, apnea events) and the reasons of monitoring. Also opinions concerning monitor usefulness and performance were gathered. The majority of our families (> 97%) consisted of both parents, their socio-economic status was medium (52.11%) or good (46.48%) and they were residents of cities (88.73%). Cigarette smoking was present in 22 families (31%) with 13 smoking mothers (18.31%). Mothers' mean age was 29.11 years (SD 4.84), 45% of them had high school education and 36.62%-university education. As many as 45% of the pregnancies had a pathological course and 34.3% were terminated by a preterm delivery. Mean birth weight of monitored children was 2914.93 g (SD 971.4), mean Apgar score was 8.31 (SD 2.46). More than 60% of children were breast fed during the first six months of life, and 30% of them--during first year of life. Bed sharing was reported in only 8% of children. Apnea episodes were observed in 30 infants (42.25 of whole group), in 20 of them only during the neonatal period. More apnea episodes were present in premature infants (48% of premature versus 30% of full term infants). Only 12 children (16.9% of whole group) manifested apnea events during the monitoring period. However, almost all the parents (97%) had a high opinion of the role played by the monitor (mean monitoring time 7.12 months, SD 4.44). In 27 families (38%) a cause of monitoring was a preceeding apnea event. The decision of remaining parents was based exclusively on fear. This fear was justified only in a small number of families (previous SIDS victim, GER). Numerous children were monitored solely on the basis of information of apnea existence in children. Such a difficult to accept monitoring reason probably has its source in inappropriate family health education.
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PMID:[Apnea states in infants, anxiety of parents and pediatricians, and home monitoring of respiration in children]. 1101 59

SIDS and ALTE are different entities that somehow show some similarities. Both constitute heterogeneous conditions. The Netherlands is a low-incidence country for SIDS. To study whether the same would hold for ALTE, we studied the incidence, etiology, and current treatment of ALTE in The Netherlands. Using the Dutch Pediatric Surveillance Unit, pediatricians working in second- and third-level hospitals in the Netherlands were asked to report any case of ALTE presented in their hospital from January 2002 to January 2003. A questionnaire was subsequently sent to collect personal data, data on pregnancy and birth, condition preceding the incident, the incident itself, condition after the incident, investigations performed, monitoring or treatment initiated during admission, any diagnosis made at discharge, and treatment or parental support offered after discharge. A total of 115 cases of ALTE were reported, of which 110 questionnaires were filled in and returned (response rate 97%). Based on the national birth rate of 200,000, the incidence of ALTE amounted 0.58/1,000 live born infants. No deaths occurred. Clinical diagnoses could be assessed in 58.2%. Most frequent diagnoses were (percentages of the total of 110 cases) gastro-esophageal reflux and respiratory tract infection (37.3% and 8.2%, respectively); main symptoms were change of color and muscle tone, choking, and gagging. The differences in diagnoses are heterogeneous. In 34%, parents shook their infants, which is alarmingly high. Pre- and postmature infants were overrepresented in this survey (29.5% and 8.2%, respectively). Ten percent had recurrent ALTE. In total, 15.5% of the infants were discharged with a home monitor. In conclusion, ALTE has a low incidence in second- and third-level hospitals in the Netherlands. Parents should be systematically informed about the possible devastating effects of shaking an infant. Careful history taking and targeted additional investigations are of utmost importance.
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PMID:Surveillance study of apparent life-threatening events (ALTE) in the Netherlands. 1954 71


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