Gastroesophageal reflux and apnea in prematurely born infants during wakefulness and sleep

Article Abstract:

To determine whether a relationship exists between gastroesophageal reflux (GER; in which the contents of the stomach are regurgitated back up into the esophagus) and persistent apnea (periods where breathing completely stops) in premature infants, a study of 20 infants was carried out. Apneas of prematurity usually disappear by the time the infant reaches the age of 37 gestational weeks, but they may recur later in infancy. The patients in this study had been treated in the intensive care unit after birth and were studied after 37 weeks' gestational age. Fourteen were symptomatic, with persistent apnea and regurgitation after feeding; the remaining six were asymptomatic. Infants' respiratory patterns were monitored by recording thoracic and abdominal movements, while esophageal pH (acidity) was measured with a tiny microelectrode positioned a few centimeters above the entry to the stomach. Sleep cycles were also recorded. All infants experienced episodes of GER, with pathologic GER (defined according to the extent of acid increase) observed in 10 of the 14 symptomatic infants and in 2 of the 6 asymptomatic ones. Apneas (pauses in breathing that lasted more than 10 seconds) were called central if accompanied by cessation of both respiratory movements and airflow through the nose. This type was recorded in six symptomatic infants and no asymptomatic infants. Ten symptomatic infants had a total of 113 obstructive (in which nasal airflow stopped while respiratory movements continued) and mixed (involving both central and obstructive patterns) apneas, while such apneas were seen in only one asymptomatic subject. No correlation was seen between the number of obstructive or mixed apneas and GER for either group. A brief review of the medical literature concerning the relationship between GER and apnea is presented. (Consumer Summary produced by Reliance Medical Information, Inc.)

Physiological aspects, Infants (Premature), Premature infants

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Beta-galactosidase tablets in the treatment of lactose intolerance in pediatrics

Article Abstract:

Children with lactose intolerance have decreased or no activity of lactase (also called beta-galactosidase), an enzyme that is required for the breakdown and absorption of lactose from the intestinal tract. Lactose intolerance is associated with flatulence, abdominal pain, and diarrhea occurring shortly after milk products are consumed (lactose is the main carbohydrate in milk). The effectiveness of lactase-containing tablets in decreasing symptoms associated with lactose intolerance was assessed in 18 children with lactose intolerance but no underlying gastrointestinal disease. The average age was 11 years, and 74 percent of the subjects were boys. Lactase-containing tablets or a placebo, a substance with no therapeutic effect, were taken before drinking a solution of lactose. The breath of the children was analyzed for the levels of hydrogen every 30 minutes for two hours. Hydrogen levels in the breath, which serve as a measure of the inability to break down lactose, were 60 parts per million (ppm) in patients given a placebo and seven ppm in patients give the lactase-containing tablets. Increased hydrogen production was associated with clinical symptoms of lactose intolerance in placebo-treated patients, including abdominal pain in 89 percent, bloating in 83 percent, diarrhea in 61 percent, and flatulence in 44 percent. These findings show that lactase-containing tablets, taken before ingesting lactose, reduce the excretion of hydrogen in the breath and the abdominal symptoms caused by lactose intolerance. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Pediatric diseases, Lactase, Beta galactosidase, Digestive enzymes, Lactose intolerance, Lactose intolerance in children

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Gastroesophageal reflux-induced hypoxemia in infants with apparent life-threatening event(s)

Article Abstract:

Apparent life-threatening event(s) or ALTE is the new term for the syndrome known previously as near-miss sudden infant death syndrome. This syndrome is characterized by apnea (cessation of breathing) plus some combination of skin color change, altered muscle tone, choking, and gagging. ALTE episodes can occur when the infant is asleep, or while awake after feeding. It has been reported that infants with ALTE frequently have gastroesophageal reflux (GER), the backing up of acid and food from the stomach into the esophagus. In order to determine whether episodes of esophageal acidification in ALTE infants are associated with abnormal heart or lung functioning, 16 ALTE infants and six control infants were studied; the control infants had clinical symptoms of GER but no history of ALTE. Although only two of the ALTE infants had symptoms of vomiting, the incidence of GER was similar in the ALTE group and the GER group. Evaluation of oxygen desaturation indicated that there was a significant correlation between the duration of esophageal acidification and the length of episodes of hypoxia, oxygen deprivation which can cause skin color changes and rapid heart beat. The study results suggest that GER is common in babies with ALTE and that GER may be associated with hypoxic episodes. In infants with ALTE, it may be advisable to perform prolonged monitoring of esophageal acidity, along with the usual evaluation for apnea. (Consumer Summary produced by Reliance Medical Information, Inc.)

Research, Causes of, Sudden infant death syndrome

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