THE RELATIONSHIP OF RESPIRATORY COMPLICATIONS FROM GASTROESOPHAGEAL REFLUX TO PREMATURITY IN INFANTS

The association between respiratory complications of gastroesophageal reflux (GER) and prematurity in infants has not been described completely. We studied 82 consective infants less than 6 months of age with major respiratory symptoms suspected to be caused by GER. Twenty-eight patients had bronchopulmonary dysplasia (BPD). Extended (18 to 24 hours) esophageal pH monitoring was used to document GER with a pH score. Respiratory complications were considered to be caused by GER if a prolonged mean duration of sleep reflux (ZMD) was found. Seventy-five of the 82 (91%) infants had documented GER, but only 45 (55%) had a prolonged ZMD. The incidence of GER was high regardless of the gestational age at birth, postconceptual age at time of study, and the presence of BPD. The incidence of a prolonged ZMD was higher in infants who were 34 to 39 weeks' gestation (10/12, 83%) than in infants who were less than 34 weeks' gestation at birth (15/37, 41%; P=.01). The incidence of a prolonged ZMD was lowest in infants 39 weeks or less postconceptual age at the time of study (4/14, 29%; P=.017). Most infants with BPD did not have a prolonged ZMD (12/28, 43%). However, 11 of the 12 (92%) infants with BPD and a prolonged ZMD showed dramatic improvement after effective antireflux therapy compared with 0 of 16 infants with BPD and normal ZMD (P<.001). In conclusion, the incidence of reflux-induced respiratory complications as determined by a prolonged ZMD appears to be low in infants before 39 weeks postconceptual age, even though the incidence of GER is high. This observation suggests that the development of a prolonged ZMD may involve factors other than GER that occur near term. The presence of a prolonged ZMD is probably not a major factor in the development of BPD, but it may delay recovery from BPD. © 1990 W.B. Saunders Company.