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GOR IN FLAT AND REVERSED-TRENDELENBURG (10°) SUPINE POSITION, AND ITS RELATION TO APNOEA AND BRADYCARDIA IN APPARENT LIFE THREATENING EVENTS (ALTE).

Vandenplas, Y.; Vandemaele, K.; Denayer, E.

Journal of Pediatric Gastroenterology & Nutrition: April 1997 - Volume 24 - Issue 4 - p 479
Annual Meeting Of The European Society Of Pediatric Gastroenterology And Nutrition Thessaloniki, May 21-24, 1997
Free

Academisch Ziekenhuis Kinderen, Free Univ. of Brussels, Belgium.

Aim The recommended sleeping position for infants is flat supine (FS). Since GOR occurs more frequently supine than prone, it is emphasized that GOR in the FS position might frequently be related to ALTE incidents in infants, caused by apnoea and/or bradycardia. Many paeditricians recommend empirically the reversed-Trendelenburg supine (RTS) position in regurgitating infants.

Methods A polygraphic recording of heart rate, respiratory rate, nasal flow, EEG and eye movements (Medatec), in combination with an oesophageal pH monitoring (Mark III, Synectics) during (at least) 8 hours sleep was performed in 40 infants, 4 to 15 weeks old, admitted because of an ALTE during sleep. All babies had been found pale, and/or hypotonic by an observer, but had completely recovered when presented at the emergency ward. Physical examination was normal in all babies. All babies were normally fed (breast feeding or formula); the methodology of the pH-metry was according to the ESPGAN recommendations. The 8 hours sleep were divided in two periods of 4 hours, with FS or RTS at 10° sleeping position as variable (20 infants first slept in FS, and 20 others slept first in RTS).

Results None of the infants repeated an ALTE during the observation period. 245 central apnoeas (CAs) of > 5 s were observed in 35/40 (87%) infants; 20 CAs of > 15 s was observed in 7/40 (17%) infants; 53 obstructive apnoea (OA) of > 3 s were observed in 18/40 (45%) infants: OA of > 5 s with significant bradycardia (<80/min) or desaturation (<90%) without movement was observed in 4/40 infants (10%) (with respectively 4,5,5 and 8 such episodes). The reflux index (RI:% time pH<4.0 was >10% in 23/40 infants (57%), and <5% in 6/40 (15%). No significant difference was observed in RI in relation to the sleeping position (FS versus RTS: 19.5 versus 21.7%), although there were individual variations (in both directions: some infants had a lower RI in FS than in RTS position; in others the opposite was observed). In not one infant, there was a temporal relation between a respiratory event (central or obstructive apnoea) and GOR (pH < 4.0).

Conclusion Abnormal pH monitoring data were observed in 53% of the infants presenting with an ALTE during sleep. However, in none of these infants there was any evidence to suggest a causal relation between the ALTE and GOR. There is no difference in pH monitoring data in the flat-supine or reversed-Trendelenburg-supine (10°) sleeping position. Therefore, the RST-sleeping position cannot be recommended in the treatment of GOR.

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