P1040 GASTROESOPHAGEAL REFLUX (GER) AND APPARENT LIFE THREATENING EVENT (ALTE); IS THERE A RELATIONSHIP?

Abstract

Introduction: Previous studies have shown a variable incidence of GER among infants with ALTE. The goals of this study were to characterize the incidence of pathologic GER in our patient population with ALTE and to define an association between GER and ALTE. Methods: We conducted a retrospective chart review of infants who underwent pH probe as part of ALTE workup at New York Presbyterian-Weill Cornell Medical Center over the past 5 years. Patients with complex medical problems and inpatients were excluded. We analyzed data including date of birth, age at the time of ALTE, previous symptoms of GER, and description of feeds. pH probes were conducted using single or double channels for a minimum of 20 hours, with 2 acid provocations. Number of reflux episodes, time of longest episode, and reflux index (RI) were recorded. If reflux occurred following provocation, 30 minutes were subtracted from the total time. Pathologic reflux was defined as a RI of >12%. Delayed esophageal clearance was defined as a reflux episode longer than 20 minutes. Results: Twenty-six infants, 15 males and 11 females, ages 1 day to 8 months were included. Forty-six percent(12) were preterm infants (median gestational age 34 weeks). The mean age at the time of ALTE event was 47.6 days in premature infants and 44.9 days in full-term infants. There were 11 dual and 15 single-channel probes. Presentations of ALTE included cyanosis or color change in 57%(16) patients and apnea/gasping and/or floppiness in 38%(10). No patient had an ALTE episode during the pH probe. Six infants had previous GER symptoms. The mean RI in the lower probe was 2.6% in preterms and 3.4% in full-terms, thus no infant had pathologic GER. The mean number of reflux episodes was similar in preterms (49.9) compared to full-terms (58.6). The mean longest episode in preterms was 72.5 minutes compared with 44.3 for full-terms. Eighty-one percent(13/16) of patients with cyanosis had delayed esophageal clearance(mean time 70 minutes). Conclusion: It is remarkable that based on current pH probe guidelines, no patient had pathologic GER in this seemingly high-risk group. We cannot comment on the association between ALTE and GER as there were no recorded ALTE symptoms during the pH. In our study, patients with cyanosis were more likely to have delayed esophageal clearance. We may hypothesize that episodes of acid reflux associated with prolonged esophageal exposure may be responsible for a cyanotic event,perhaps from aspiration or neuropathic mechanism. Further studies investigating the relationship of acid reflux and ALTE using concomitant pH probe and polysomnography are warranted.