Department of Pediatrics, Neonatology, Johns Hopkins Hospital and School of Medicine, Baltimore, MD 21224-2780, USA.
J Pediatr Gastroenterol Nutr. 2011 May;52(5):523-31. doi: 10.1097/MPG.0b013e3181fa06d7.
The aim of the study was to examine temporal association (TA) between polysomnographic cardiorespiratory (CR) events and gastroesophageal reflux (GER) in premature infants with persistent CR events at >39 weeks postmenstrual age and determine whether the use of multichannel intraluminal impedance (MII)-pH probe improves sensitivity of the TA compared with pH probe alone.
Seven infants born between 24 and 29 weeks' gestational age with persistent CR events at 39 to 48 weeks' postmenstrual age underwent a polysomnography with MII-pH probe. Symptom index (SI) and symptom-associated probability were calculated for diverse types of reflux and CR events. SI and a Fisher exact test with variable association windows were calculated for obstructive apnea (OA). Odds ratios for an OA given a reflux event and for a reflux event given an OA were determined.
With a Fisher exact test, a subject-specific association between MII events and OA was found in the 3 patients who required a fundoplication or had the worse clinical GER. Some level of TA was found with SI and symptom-associated probability in 6 of 7 infants. Association was found for pH > 4 and pH ≤ 4 reflux events. pH-only events with no change of MII had only a limited role in generating CR events.
TA between CR events and GER was found in a single-subject-level analysis in some infants with persistent CR events at term. This TA suggests a causal relation between CR and reflux events that was further strengthened by the clinical outcomes of each infant.
本研究旨在探讨胎龄 24-29 周早产儿在超过 39 孕周后仍存在持续性呼吸暂停（CR）事件时，多导睡眠图（PSG）中心肺（CR）事件与胃食管反流（GER）之间的时间关联（TA），并确定多通道腔内阻抗（MII）-pH 探头的使用是否比 pH 探头单独使用提高 TA 的敏感性。
7 名胎龄 24-29 周、在 39-48 孕周时仍存在持续性 CR 事件的早产儿进行了 PSG 和 MII-pH 探头检查。计算了不同类型反流和 CR 事件的症状指数（SI）和症状相关概率。计算了阻塞性呼吸暂停（OA）的 SI 和具有可变关联窗口的 Fisher 确切检验。确定了 OA 发生反流事件的优势比和反流事件发生 OA 的优势比。
通过 Fisher 确切检验，在 3 名需要胃底折叠术或具有更严重临床 GER 的患者中，发现了 MII 事件与 OA 之间存在个体相关性。在 7 名婴儿中的 6 名中，使用 SI 和症状相关概率发现了某种程度的 TA。pH > 4 和 pH ≤ 4 反流事件均存在 TA。pH 仅事件且 MII 无变化仅在一定程度上导致 CR 事件。
在一些在足月时仍存在持续性 CR 事件的婴儿中，通过单例水平分析发现了 CR 事件与 GER 之间的 TA。这种 TA 提示 CR 和反流事件之间存在因果关系，每个婴儿的临床结果进一步加强了这种关系。
Zotero 插件