Apnea In Infants Research Articles

Evaluation of Obstructive Sleep Apnea in Prone Versus Nonprone Body Positioning With Polysomnography in Infants With Robin Sequence.

Management of obstructive sleep apnea in infants with Robin sequence (RS) includes prone positioning during sleep, which conflicts with safe infant sleep data. We examined changes in polysomnography (PSG) parameters for prone versus nonprone body positions in these infants. Pre-post interventional, nonblinded study. Infants with RS referred for PSG were recruited from craniofacial clinic and inpatient units at Children's Hospital Los Angeles, a tertiary pediatric center. Fourteen infants were recruited, and 12 studies were completed on both body positions; 11 studies were used in the analysis. The PSG was divided into nonprone and prone sleep, moving from their usual sleep position to the other position midway in the study. Data was collected in each position for obstructive apnea-hypopnea index (oAHI), central apnea index (CAI), sleep efficiency (SE), and arousal index (AI). Signed rank test was used to evaluate the change in body position. All infants were term except 1, age 7 to 218 days (mean: 55 days; standard deviation: 58 days), and 8 (57%) of 14 were female. From nonprone to prone sleep position, the median oAHI (16.0-14.0), CAI (2.9-1.0), and AI (28.0-19.9) decreased (P = .065); SE increased (67.4-85.2; P = .227). Prone positioning may benefit some infants with RS. However, even those with significant improvement in obstructive sleep apnea did not completely resolve their obstruction. The decision to use prone positioning as a therapy should be objectively evaluated in individual infants.

Association of Serum Albumin With Apnea in Infants With Bronchiolitis

Apnea is a rare, life-threatening complication of bronchiolitis, the leading cause of infant hospitalization in the United States. Currently, no objective method exists for identifying which infants will become apneic. To investigate whether serum albumin levels are associated with apnea in infants with severe bronchiolitis. A secondary data analysis of the 35th Multicenter Airway Research Collaboration, an ongoing multicenter cohort study of infants hospitalized for bronchiolitis, was conducted from December 11, 2018, to May 30, 2019. Seventeen hospitals across the United States enrolled infants (n = 1016) during 3 consecutive bronchiolitis seasons (November 1 to April 30) between 2011 and 2014. Infants with heart-lung disease or a gestational age less than 32 weeks were excluded. Serum albumin level was categorized as low (<3.8 g/dL) or normal (≥3.8 g/dL). Apnea during the hospitalization. Of the 1016 infants hospitalized for bronchiolitis, the median (interquartile range [IQR]) age was 3 (2-6) months, 610 (60.0%) were male, and 186 (18.3%) were born preterm (32-37 weeks' gestation). Among the 25 infants (2.5%) with apnea while hospitalized, the median (IQR) serum albumin level was 3.5 (3.1-3.6) g/dL, and 22 (88.0%) had low serum albumin levels. The prevalence of apnea was 5.7% among all infants with low albumin levels, compared with 0.5% prevalence in infants with normal serum albumin levels. In unadjusted analyses, apnea was associated with younger age, preterm birth, weight-for-age z score, and low albumin (odds ratio [OR], 12.69; 95% CI, 3.23-49.82). After adjustment for age, preterm birth, and weight-for-age z score, low serum albumin levels remained statistically significantly associated with apnea (OR, 4.42; 95% CI, 1.21-16.18). Low serum albumin levels appeared to be associated with increased risk of apnea after adjustment for known apnea risk factors. This finding provides a path to potentially identifying apnea, a life-threatening complication of bronchiolitis.

Is Aromatherapy Effective for Apnea in Preterm Infants? A Systematic Review

Background: Apnea can be associated with many complications such as bradycardia, cyanosis, hypotension, hypotonia, hydrocephalus, neurologic complications, and even death. Pharmacological treatment is associated with many side effects. We aimed to investigate the effect of aromatherapy on Apnea in premature newborns. Materials and Methods: An extensive search was done in databases of Medline, Embase, Scopus, Cochrane, and Web of Science until February 2019. Two independent researchers screened articles, in the next step, full texts of probably relevant articles were summarized and categorized based on the evaluated outcomes and overall effect size was presented. Results: Three studies were included in the systematic review (including 110 preterm infants). Aromatherapy with breast milk odor not with vanilla odor, caused variability of premature infants’ heart rate blood oxygen saturation during and after venipuncture. Calming effects were observed when preterm newborns were exposed to either vanilla or breast milk odors during venipuncture; however, only breast milk odors had a calming effect on subjects after sampling. Breast milk odor was more effective regarding calming effects on premature infants. Infants in olfactory stimulation with anise or cinnamon were discharged from hospital 3.4 days earlier than the control group (p = 0.12). A subgroup analysis of subjects with a body weight of 2,000 grams or more showed a shorter hospitalization period. When compared by gender, better effect was observed in boys than girls with shorter hospitalization in NICU. Conclusion Aromatherapy can be effective for apnea in preterm infants. Due to the small number of participants and low number of articles, the conclusion should be interpreted with caution.

Sa1293 – Transpyloric Feed in Gastroesophageal Reflux Assocciated Apnea in Premature Infants : A Prospective Study

Sa1293 – Transpyloric Feed in Gastroesophageal Reflux Assocciated Apnea in Premature Infants : A Prospective Study

经鼻同步间歇指令通气对早产儿频发性呼吸暂停的疗效观察

经鼻同步间歇指令通气对早产儿频发性呼吸暂停的疗效观察

无创双水平正压通气联合枸橼酸咖啡因治疗早产儿频繁呼吸暂停的效果观察

无创双水平正压通气联合枸橼酸咖啡因治疗早产儿频繁呼吸暂停的效果观察

Comparative observational study of aminophylline with prophylactic and therapeutic uses for clinical outcomes in preterm infants

Objectives Aminophylline has been used for prevention or treatment of apnea in preterm infants with idiopathic apnea of prematurity. The aim of this study was to assess the clinical usefulness of prophylactic in comparison with therapeutic aminophylline therapy. Methods This retrospective observational study included infants born with a birth weight of &amp;lt; 2,500 g or at &amp;lt; 36 weeks of gestation. Infants born between August 2013 and July 2014 who received aminophylline therapy within 24 hr after birth were assigned to the prophylactic group, while infants born between August 2014 and July 2015 who received aminophylline therapy after obvious apnea were assigned to the therapeutic group. We compared clinical characteristics, including days of ventilator and oxygen therapy and bronchopulmonary dysplasia (BPD) between both groups. Results Sixty—four patients and 25 infants were identified in the prophylactic and therapeutic groups, respectively. The mean gestational age and birth weight were 32.57 ± 1.96 weeks and 1765 ± 205 g, respectively, in the prophylactic group and 32.46 ± 1.82 weeks and 1770 ± 250 g, respectively, in the therapeutic group. No significant differences in clinical characteristics were found between the two groups. Similar clinical outcomes, including days of ventilator and oxygen therapy, intraventricular hemorrhage (IVH), periventricular leukomalacia, and BPD, were observed between the two groups. Conclusions The present study showed that the prophylactic use of aminophylline does not improve the clinical outcomes, including BPD, IVH, and ventilator dependency as compared with therapeutic use. In other words, routine prophylactic use of aminophylline is unnecessary.

Efficacy and Safety of Different Maintenance Doses of Caffeine Citrate for Treatment of Apnea in Premature Infants: A Systematic Review and Meta-Analysis.

Background Caffeine is widely used for the treatment of neonatal apnea, but there is no agreement on the optimum maintenance dose for preterm infants. Objective The aims of this meta-analysis were to compare the efficacy and safety of high versus low maintenance doses of caffeine citrate for the treatment of apnea in premature infants. Methods Literature searches were conducted using PubMed, Cochrane Library, OVID, Embase, Web of Science, Chinese Biomedical Literature, Weipu Journal, Wanfang, and CNKI databases up to September 2018. Only randomized controlled trials (RCTs) of caffeine citrate for apnea treatment in premature infants were included. Trials were divided into those testing high maintenance doses (10−20 mg/kg daily) and low maintenance doses (5−10 mg/kg daily) for comparison. Data collection and extraction, quality assessment, and data analyses were performed according to the Cochrane standards. Results Among the 345 studies initially identified, thirteen RCTs involving 1515 patients were included. Compared to the low-dose group, the high-dose group exhibited greater effective treatment rate (RR: 1.37, 95%CI: 1.18 to 1.60, P<0.0001) and success rate for ventilator removal (RR: 1.74, 95%CI: 1.04 to 2.90, P=0.03), but higher incidence of tachycardia (RR: 2.02, 5%CI: 1.30 to 3.12, P=0.002). The high-dose group also demonstrated lower extubation failure rate (RR: 0.5, 95%CI: 0.35 to 0.71, P=0.0001), frequency of apnea (WMD: -1.55, 95%CI: -2.72 to -0.39, P=0.009), apnea duration (WMD: -4.85, 95%CI: -8.29 to -1.40, P=0.006), and incidence of bronchopulmonary dysplasia (RR: 0.79, 95%CI: 0.68 to 0.91, P=0.002). There were no significant group differences in other adverse events including in-hospital death (P>0.05). Conclusions Higher maintenance doses of caffeine citrate appear more effective and safer than low maintenance doses for treatment of premature apnea, despite a higher incidence of tachycardia.

Obstructive Sleep Apnea and Sleep Position: Does It Matter for Infants With a Cleft Palate?

To determine whether nonsupine sleep improves obstructive sleep apnea (OSA) in infants with cleft palate undergoing polysomnography (PSG). Retrospective chart review. Tertiary care pediatric hospital. Twenty-seven infants (1 month to 1 year) with cleft palate with or without cleft lip (CP ± L) undergoing PSG testing for suspected OSA were included. Polysomnography measures included obstructive apnea-hypopnea index (OAHI), central apnea-hypopnea index (CAHI), oxygen saturation (SpO2) nadir, SpO2, and end-tidal carbon dioxide (ETCO2). Twenty-three PSGs with at least 20 minutes of sleep in both the supine and the nonsupine positions were analyzed. The supine OAHI (mean: 16.8 events/hour; standard deviation [SD]: 18.5) and nonsupine OAHI (mean: 12.6 events/hour; SD: 12.6) did not differ significantly (P = .10). The supine CAHI (mean: 1.9 events/hour; SD: 2.7) and nonsupine CAHI (mean: 3.1 events/hour; SD: 3.7; P = .15), the supine SpO2 nadir (mean: 81.2%; SD: 6.3) and nonsupine SpO2 nadir (mean: 81.8%; SD: 5.3; P = .70), the supine mean SpO2 (mean: 95.5%; SD: 1.9) and nonsupine mean SpO2 saturation (mean: 95.3%; SD: 2.4; P = .34), and the supine ETCO2 (mean: 45.4 mm Hg; SD: 5.3) and nonsupine ETCO2 (mean: 42.5 mm Hg; SD: 10.1; P = .24) were also similar. There were no significant improvements in OSA metrics during nonsupine sleep in infants with CP ± L. Prior to recommending nonsupine positioning which increases infant's exposure to sudden infant death syndrome risk, we advocate obtaining a PSG to verify an objective improvement in OSA.

Apnea in infants hospitalized with pertussis: Incidence and gestational smoking association.

Apnea is a life-threatening complication of pertussis, now a re-emerging cause of infant hospitalization worldwide. The incidence of apnea during pertussis ranges widely. The aim of this study was therefore to determine the incidence of apnea in hospitalized infants diagnosed with pertussis and to identify relevant risk factors for apnea. This was a retrospective analytical study. We included children hospitalized with pertussis at a tertiary hospital during a 5year period from 2010 to 2015. Nasopharyngeal aspirates (NPA) were obtained in all subjects. Real-time polymerase chain reaction was used to test NPA samples for Bordetella pertussis. The daily charts were assessed to identify inpatients with apnea. Multivariable logistic regression was performed to identify independent risk factors for inpatient apnea. Inpatient apnea was identified in 51 of 147 infants with pertussis confirmation (34.7%: 95%CI: 27-42%). Maternal smoking during pregnancy was the only statistically significant, independent predictor of inpatient apnea (OR: 4.48; 95%CI: 1.35-14.8). No statistically significant association was found with gender, corrected age; birthweight, caregiver smoking; lactation, weight at admission <3rd percentile, or hematological parameters. The incidence of pertussis apnea was nearly one in three hospitalized infants, and was fourfold more frequent in infants whose mothers smoked during pregnancy.

Is Tongue-Lip Adhesion or Mandibular Distraction More Effective in Relieving Obstructive Apnea in Infants With Robin Sequence?

Tongue-lip adhesion (TLA) and mandibular distraction osteogenesis (MDO) are the most common operations for obstructive apnea (OA) in infants with Robin sequence (RS). The purpose of this study was to compare early outcomes of TLA and MDO on resolution of OA. This is a retrospective cohort study of infants with RS treated with TLA or MDO from 2005 through 2018. To be included, patients had to have polysomnograms pre- and postoperatively unless intubated or tracheostomy dependent. Patients were excluded if the operation occurred after 1year of age. The primary predictor variable was type of operation (TLA or MDO). The primary outcome variable was "successful resolution of OA," defined as 1) postoperative apnea-hypopnea index (AHI) score lower than 5, 2) postoperative OA severity score of 0 to 1 (no to mild OA), and 3) no need for additional airway intervention during the first year of life. Descriptive, bivariate, and regression analyses were performed. Statistical significance was set at a P value less than .05. Forty-three patients were included (TLA, n=19 [44%]; MDO, n=24 [56%]). Eighteen patients (41%) were syndromic. Patients in the TLA group were significantly younger at operation (28.2±23.1days) compared with those in the MDO group (87.1±81.7days; P=.002). The MDO group had more severe preoperative OA (AHI score, 20.5±14.9; OA severity score, 4.7±0.8) than the TLA group (AHI score, 17.6±31.0; OA severity score, 3.6±1.4; P<.041). Postoperative AHI score and OA severity score for the TLA group were 11.7±19.5 (33.5% decrease; P=.496) and 2.3±1.8 (improvement by 1.3±2.4 levels; P=.051), respectively. Postoperative AHI score and OA severity score for the MDO group were 1.1±1.8 (94.6% decrease; P<.001) and 0.2±0.4 (improvement by 4.6±0.8 levels; P<.0001), respectively. Successful resolution of OA occurred in 9 patients (47%) in the TLA group and 22 patients (92%) in the MDO group. Postoperative complications were similar. MDO is more effective than TLA in relieving OA in infants with RS.

Caffeine and supplemental oxygen effectively suppress periodic breathing with only minor effects during long episodes of apnoea in preterm infants.

We investigated the characteristics and effects of sleep stage, supplemental oxygen and caffeine on periodic breathing (PB) and apnoea of prematurity (AOP) in preterm infants. This 2013-2015 study recruited 21 preterm infants on neonatal wards in the Helsinki and Uusimaa Hospital District, Finland, at a median corrected gestational age of 35.7weeks and performed polysomnography at baseline, during supplemental oxygen and during caffeine treatment. All infants demonstrated PB, during a median of 11% of sleep time and 85% of PB occurred during non-rapid eye movement sleep (NREM). Apnoea episodes were brief during PB, but 66% were associated with oxygen desaturation. Supplemental oxygen substantially reduced PB time by 99% and caffeine by 91%. Oxygen desaturation decreased from 38 per hour at baseline to 8.5 with oxygen and 24 with caffeine (all p<0.001). AOPs decreased from 1.4 per hour at baseline to 0.4 with oxygen (p=0.03) and 0.3 with caffeine (p=0.07). Most (84%) apnoea episodes over 15seconds were mixed episodes during REM sleep. PB occurred predominantly during NREM sleep, caused intermittent hypoxia, and was suppressed by supplemental oxygen and caffeine. In contrast, long apnoea episodes representing AOP were only modestly decreased.

Limb amputation of an infant with transposition of great arteries using spinal anesthesia

Introduction: Spinal and caudal anesthesia are useful anesthetic techniques for infants compared to general anesthesia. In case of infants lumbar puncture can be safely performed at or just below the intercristal line. Due to the presence of loose fatty tissues in the caudal extradural space, it becomes safe and easy to insert a cannula enabling easy cranial spread of local anesthetic drugs. Increased production and absorption of cerebrospinal fluid in infants lead to administration of higher doses of local anesthetics. However, this spinal and caudal anesthesia has lesser risk of post-operative apnea in infants compared to general anesthesia. Case Report: A three-month-old male infant, whose body weight was seven and half kilograms, was afflicted with ischemia which extended to half of his right leg. There was gangrene on his right big toe as well. These developments occurred after cardiac catheterization was implemented through right femoral vein cannulation. Due to high-risk of transposition of great arteries in general anesthesia, the surgeons finalized under spinal anesthesia in order to bypass the infected respiratory system, prevent aspiration because of full stomach, and to get better postoperative analgesia. Conclusion: Spinal anesthesia is an alternative option to general anesthesia in high risk patients owing to its safety. However, in case of spinal complications or failure of spinal anesthesia, the anesthetist should always get ready with the high risk general anesthesia.

The effect of mechanical or electrical stimulation on apnea length in mice.

Premature birth is a leading cause of infant mortality which is often attributed to irregular breathing and apnea of prematurity. A common treatment for apnea is caffeine to stimulate the brain's respiratory center. However, caffeine's long term effect on infant development is not fully comprehended. We hypothesized that noninvasive localized body stimulation regularizes breathing pattern. We investigated the impact of electrical or mechanical stimulation on breathing in mice. After the mice were ventilated for 28s to induce apnea, mice were taken off the ventilator while receiving mechanical, electrical, or no stimulation in a randomized order. Both stimuli targeted the diaphragm area through a custom-built belt with vibrating motors or adhesive electrodes. After each apnea cycle, the time to take the first breath (T) was recorded. The electrical stimulation given at 4.5, 8.3, 16.7V (pulse rate = 3Hz, pulse width = 120μs) showed no reduction in T. Electrical stimulation at pulse rates of 10 or 20Hz (16.7V, pulse width 260μs) showed a detrimental effect increasing T by ~ 7% compared to control values (p = 0.005, p = 0.038 respectively). High and medium intensity mechanical stimulations significantly reduced T by 11.74 (p < 10-13) and by 17.08% (p < 10-8), respectively. Further reducing the amplitude of vibrations did not affect T. When the probe was attached to the ankles, only the high intensity vibrations resulted in a decrease in T (p < 10-13). Mechanical vibrations, applied at various intensities and locations, could be used to treat irregular breathing and apnea in infants.

Shifting the Paradigm: The Quiet Revolution of Pediatric Procedural Sedation Practice.

On April 12, 1945, Dr Gold1 from Weill Cornell Medicine (formerly Cornell University Medical College) presented a review titled “Sedatives and Stimulants in Pediatric Practice” to the section of pediatrics. He stated that he was “disappointed indeed to learn how scant were the revelations of pediatric views on these matters” and then reviewed the primary sedatives of that time for children (barbiturates and chloral hydrate). Over the next 50 years, the vast majority of “conscious” sedation in pediatrics was still being provided with barbiturates and chloral hydrate. Because of this lack of evolution, many of the seminal articles that have been used to guide the mechanics of pediatric sedation practice emanated from 2 sources: data from sedated procedures performed with these traditional long-acting agents and data from general anesthetic cases that were extrapolated to be relevant to procedural sedation. One issue that has been largely governed by these data sets is the risk of apnea and need for prolonged observation in former term and preterm infants after a sedated procedure. The literature regarding the risk of postanesthetic apnea in infants is robust. Infants who were born prematurely carry the most notable risk, as has been described in a number of reports.2–6 Apnea has also been seen postoperatively in term infants with no previous history or known risk factors for apnea.7 In a large, multicenter review in which researchers examined risk factors for postoperative apnea in former preterm infants, postconceptual age (PCA), gestational age, and continued use of a home …

Apnea in Preterm and Term Infants After Deep Sedation and General Anesthesia.

Determine the incidence of apnea in preterm and term infants after deep sedation (DS) compared with general anesthesia (GA). A retrospective chart review was performed on infants who underwent elective DS or GA from January 2008 to December 2013, were <60 weeks postmenstrual age if preterm or <50 weeks postmenstrual age if term, and were monitored for apnea as inpatients after DS or GA. Gestational age, postmenstrual age, chronologic age, anesthetic and sedative medications, procedure indication, and postsedation events were collected. There were 61 DS encounters (24 preterm and 37 term) and 175 GA encounters (120 preterm and 55 term) that met inclusion criteria. No recorded apneic events in either preterm or term infants were recorded after DS. After GA, 1.7% of infants had apneic events (2.5% preterm and 0 term; P = .57 versus DS). All events occurred within 2 hours of monitoring in recovery. None of the infants had apnea after DS. Rates from the literature would suggest that 2 to 6 of the preterm DS subjects should have experienced postsedation apnea. Sampled GA subjects had a rate of 2.5% in preterm infants exhibiting apnea after GA. Although the post-DS apnea rate is lower than what has been previously published, the small sample size and limitations of a retrospective design prevent us from directing a change in postsedation monitoring recommendations. However, we do support the need for prospective studies with strict monitoring criteria to reveal the true risk of post-DS apnea.

Control of Breathing and Apnea of Prematurity

Apnea of prematurity is a significant clinical problem manifested by an unstable respiratory pattern leading to bradycardia and hypoxemia. Most of these apneas are idiopathic and represent a physiologic manifestation of an immature control of breathing and adaptation to extrauterine life. In extremely preterm infants, this unstable breathing pattern superimposed on an immature lung that is injured by inflammation and infection may lead to frequent and profound episodes of intermittent hypoxemia. These cardiorespiratory events during early postnatal life may be associated with both short- and long-term morbidity. In this review the author discusses the most important pathophysiologic mechanisms responsible for periodic breathing and apnea in preterm infants, as well as the diagnostic assessment and therapeutic interventions that help to stabilize breathing in this unique population.

Impact of Supplemental Oxygen on Obstructive Sleep Apnea of Infants.

Treatment options may be limited for infants with obstructive sleep apnea when there is no surgically correctable upper airway lesion. We therefore evaluated, retrospectively, the efficacy of low-flow oxygen as a therapeutic option for infant obstructive sleep apnea. We reviewed the medical charts of 23 infants who had undergone a therapeutic trial of low-flow oxygen during polysomnography. Split-night polysomnography was used in 21/23 subjects while 2/23 had undergone two separate, full-night polysomnography sleep architecture and respiratory findings on the baseline polysomnogram segment that was obtained in room air were compared with the segment on low-flow oxygen (0.25–1 L/min). Wilcoxon signed rank or McNemar’s test were used as indicated for comparing apnea hypopnea index and measures of sleep architecture at baseline and with oxygen therapy. The mean (±SD) age of subjects was 4.8 (±2.7) months, with 52% being males. The median apnea hypopnea index fell from a baseline of 18 (range 7–43) to 3 (range 1–19; p = 0.001) on oxygen. The baseline median obstructive/mixed apnea index decreased from 2 (range 1–16) to 1 during oxygen therapy (range 0–1; p = 0.003). Additionally, a significant decrease in central apnea index (median interquartile range (IQR) 1 (0–2) vs. 0 (0–1), p = 0.002) was noted. Sleep efficiency remained unaffected, while O2 saturation (SaO2) average and SaO2 nadir improved on oxygen. We were able to confirm the utility of low-flow oxygen in reducing central, obstructive, and mixed apneas and improving average oxygen saturation in infants with obstructive sleep apnea (OSA).

Apnoea in infants with bronchiolitis: Incidence and risk factors for a prediction model

Abstract Introduction The presence of apnoea in acute bronchiolitis (AB) varies between 1.2% and 28.8%, depending on the series, and is one of its most fearsome complications. The aim of this study is to determine the incidence of apnoea in hospitalised patients diagnosed with AB, and to define their associated risk factors in order to construct a prediction model. Patients and method A retrospective observational study of patients admitted to a tertiary hospital in the last 5 years with a diagnosis of AB, according to the classic criteria. Data was collected on the frequency of apnoea and related clinical variables to find risk factors in a binary logistic regression model for the prediction of apnoea. A ROC curve was developed with the model. Results Apnoea was recorded during the admission of 53 (4.4%) patients out of a total of 1.197 cases found. The risk factors included in the equation were: female (OR 0.6, 95% CI : 0.27–1.37), caesarean delivery (OR: 3.44, 95% CI: 1.5–7.7), postmenstrual age ≤43 weeks (OR: 6.62, 95% CI: 2.38–18.7), fever (OR: 0.33, 95% CI: 0.09–1.97), low birth weight (OR: 5.93, 95% CI: 2.23–7.67), apnoea observed by caregivers before admission (OR: 5.93, 95% CI: 2.64–13.3), and severe bacterial infection (OR: 3.98, 95% CI: 1.68–9.46). The optimal sensitivity and specificity of the model in the ROC curve was 0.842 and 0.846, respectively (P Conclusions The incidence of apnoea during admission was 4.4 per 100 admissions of AB and year. The estimated prediction model equation may be of help to the clinician in order to classify patients with increased risk of apnoea during admission due to AB.

Interpretation of Esophageal pH Monitoring as part of Multichannel Pneumogram in Neonates: Limitations and Pitfalls - A Review Article

This review article discusses some of the challenges associated with the interpretation of esophageal pH monitoring as part of multichannel pneumogram in neonates with suspected gastroesophageal reflux and cardiorespiratory symptoms such as recurrent apnea, bradycardia and desaturations and chronic lung disease. Several of the early studies have suggested an association between GER and apnea in preterm and term infants and this has contributed to widespread use of antireflux medications in the treatment of apnea of prematurity and infants with chronic lung disease. Despite recent studies showing no temporal or causal relationship between GER and apnea or chronic lung disease referrals from pediatricians and neonatologists in community hospitals for esophageal pH monitoring as part of multichannel pneumogram remain relevant today in the Neonatal Intensive Care Units (NICU). Interpretation of esophageal pH monitoring is particularly challenging in preterm infants because of the lack of published normative data. The reflux index (RI), which represents the percentage of the total time esophageal pH<4 is the most widely used discriminator between acid and nonacid reflux. Several factors may influence the results and this article aims to highlight some of the limitations and pitfalls of this diagnostic technique.