Gastroesophageal reflux medications in the treatment of apnea in premature infants

Objective: To determine whether medications commonly used in the management of gastroesophageal reflux reduce the frequency of apnea in premature infants. Study design: We reviewed the medical records of all infants less than or equal to 36 weeks' gestational age at birth who were treated in 2 neonatal intensive care units from 1990 through 1999 and identified those who received the antireflux medications cisapride or metoclopramide in association with apnea. We averaged the frequency of apnea during the 5 days before and the 5 days after antireflux treatment was started and compared these 2 periods by paired analysis. Results: There were 164 separate courses of treatment with either cisapride or metoclopramide in 132 patients. There were 3.6 +/- 3.2 apneic episodes per day during the 5 days before treatment and 4.0 +/- 3.4 apneic episodes per day during the 5 days after treatment (P = .048). When evaluated separately, neither cisapride nor metoclopramide reduced the frequency of apnea. Stratification for documented reflux (by radiographic contrast or by pH probe analysis), concomitant use of methylxanthines or ranitidine, developmental age, feeding volume, and respiratory support did not identify a sub-group of patients whose apnca improved with antireflux treatment. Conclusion: Antireflux medications do not reduce the frequency of apnea in premature infants.