ANALYSIS OF INFANTS PRESENTING WITH FEEDING RELATED PROBLEMS AND APPARENT LIFE THREATENING EVENTS: A CLOSER LOOK AT “PSEUDOREFLUX SYNDROME.” 648

Abstract

A “Pseudoreflux Syndrome” has been described in healthy term neonates who presented with symptoms of gastroesophageal reflux (GER) with and without apnea but were found to have increased periodic breathing (PB). This initial study was limited by a small study population (n=16) and focused on the term neonate. Differentiating GER from PB is important in determining treatment. Object of this study is to analyze 5-channel pneumograms (PCGs) of infants presenting with feeding related problems and/or apparent life threatening events in order to further define and describe the phenomenon of pseudoreflux in infants. The impact of post-conceptional age (PCA) was also examined. 5-channel PCGs of all infants presenting with symptoms of GER and/or apnea to an infant apnea program between 1992 and 1995 were reviewed for sex, race, gestational age (GA), PCA at time of presentation and diagnosis. 166 5-channel PCGs of 161 infants ranging from ages 0.6 to 55 weeks were reviewed[12.1 weeks ±0.9 (SEM)]. Of the infants evaluated, 60% were male, 40% female. 52% were white, 40% African American, 6% Latino and 2% other. 5-channel PCGs of 161 infants studied revealed a diagnosis of GER in 42%, PB in 13%, GER and PB in 25% and absence of either GER and PB in 21%. Average GA was 35 weeks ± 0.4 (SEM). Using analysis of variance (Anova), mean GA was 35 weeks regardless of diagnosis (F-Ratio 0.99, P value 0.40). Average PCA was 47.3 weeks ± 0.8 (SEM). Using Anova, mean PCA was 40 weeks for PB group, 43 weeks for GER/PB group, 51 weeks for GER group and 50 weeks for other group (F-Ratio 8.8, P value 0.00). PB alone was not observed in infants over 48 weeks PCA (0/51). Majority of infants with PB were under 45 weeks PCA(48/60). In conclusion, these results confirm the importance of considering PB in infants presenting with symptoms of GER and/or apnea. Pseudoreflux Syndrome must be distinguished from true GER to institute appropriate therapy. Infants under 45 weeks PCA are at particular risk for PB and should undergo 5-channel PCGs. Pseudoreflux Syndrome is an unlikely consideration in management of infants over 48 weeks PCA.