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Early Hum Dev. 2019 Jul;134:14-18. doi: 10.1016/j.earlhumdev.2019.05.003. Epub 2019 May 18.

Correlation between cardiorespiratory events and gastro-esophageal reflux in preterm and term infants: Analysis of predisposing factors.

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Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy; Department of Woman and Child Health and Public Health, Division of Neonatology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address:
Department of Industrial Engineering and Mathematical Sciences, Università Politecnica delle Marche, Ancona, Italy.
Department of Mother and Child Health, Salesi Children's Hospital, Ancona, Italy.



The association between cardiorespiratory events (CRE) and gastro-esophageal reflux (GER) among neonates is still controversial.


To test such an association in preterm and term infants.


Prospective observational study.


Forty-seven infants with suspected GER and recurrent CRE admitted at a neonatal intensive care unit, who underwent simultaneous and synchronized 24-hour recording of heart rate (HR), peripheral oxygen saturation (SpO2) and pH-impedance monitoring (MII-pH). HR/SpO2 data were filtered to avoid artefactual episodes of hypoxia and hypoperfusion.


The main outcome measure was the symptom association probability (SAP), with a 2-minute time window. Infants with positive (>95%) and negative (≤95%) SAP index tests were compared by univariate and multivariate statistics.


Median gestational age at birth was 294/7 weeks, median age at study 36 days. We recorded 3341 GER events and 4936 CRE (4710 desaturations, 226 bradycardias); 609/4936 (12%) CRE were temporally associated with GER episodes: 338 preceded and 271 followed GER events. The SAP index was significant in 5/47 (11%) patients. The SAP index including only CRE following GER events was significant in 3/47 (6%). There was no significant difference in the number of acid, weakly acid, non-acid, pH-only events preceding or following CRE between infants with SAP-positive and SAP-negative tests. Infants with positive SAP-index tests compared to those with SAP-negative tests had lower weight gain in the three days preceding the test and tended to have lower birth weight.


GER and CRE were associated in <11% of patients. The evaluation of ponderal growth might be helpful in predicting such an association.


Apnea; Bradycardia; Esophageal pH monitoring; Gastro-esophageal reflux; Infant; Multichannel intraluminal impedance

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