Environmental tobacco smoke exposure and gastroesophageal reflux in infants with apparent life-threatening events.
OBJECTIVE
To study the hypothesis that environmental tobacco smoke exposure in infants diagnosed with an apparent life-threatening event (ALTE) could be a contributing factor to gastroesophageal reflux.


METHODS
Thirty-four polygraphic recordings of combined esophageal pH study and respiration in infants with ALTE, age 4.1 +/- 4.9 months, range 0.4-27 months, were studied. This group of children had uncomplicated perinatal history, no congenital anomalies, no neuropathology, and no drug exposure. A written questionnaire was administered to the parents to determine the following: environmental variables, degree of environmental tobacco smoke (ETS) exposure (number of cigarettes/day), and nutrition (breast vs. bottle feeding).


RESULTS
There was a strong correlation between pH study parameters and ETS exposure (p < 0.005). The esophageal pH parameters were markedly elevated in the ETS-exposed group and in this group there was a linear relation between the number of cigarettes smoked per day and reflux index, as well as reflux > 5 min/hr (p < 0.05, r = 0.46). Nursing mothers were less likely to be smokers (18.2% vs. 34.0%). The only significant respiratory finding was in the obstructive/mixed apnea group; there was strong association between ETS exposure and high reflux index (p < 0.05).


CONCLUSIONS
We conclude that ETS exposure represents a significant contributing factor to GER. Pediatricians should systematically ask questions about the infant environment, explain the risk of ETS exposure to the caretaker, and recommend that children should remain in a smoke-free environment.
Alaswad
B
B
University of Oklahoma Health Sciences Center Department of Pediatrics, Oklahoma City, USA.
Toubas
P L
PL
Grunow
J E
JE
D001049:Apnea / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D004947:Esophagus / Q000378:metabolism; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic; D012189:Retrospective Studies; D014028:Tobacco Smoke Pollution / Q000009:adverse effects*
D014028:Tobacco Smoke Pollution