title: Influence of central apnea in the preterm newborn with gastroesophageal reflux disease.
abstract: BACKGROUND
  Gastroesophageal reflux occurs frequently in newborns. A relationship has been suspected between reflux and apnea of prematurity. The objective of this study is to determine this relationship, owing to the fact that premature newborns have immaturity of structures, especially esophageal smooth muscle.
  
  
  METHODS
  We conducted a longitudinal, analytical, comparative, and observational case/control study. The study was carried out at the Neonatal Intensive Care Unit and in the Gastrointestinal Physiology Department of the Hospital Español (Mexico City) between January 2002 and December 2004.
  
  
  RESULTS
  We included 22 patients: 11 females and 11 males. Mean age was 17.8 ± 8.4 days. Premature newborns represented 72.72% (n = 16). Mean gestational age was 33.1 ± 4.18 weeks. All cases were suspicious for central apnea except for three patients with a mixed cause of apnea. All were submitted to a 24-h pHmetry and a simultaneous polysomnography. Polysomnography was positive in 59% (n = 13) and pHmetry was positive in 50% (n = 11). Prematurity had a strong positive relation with central apnea of the newborn (odds ratio: 15 (p = 0.0154)). Odds ratio for association of central apnea and gastroesophageal reflux was 3.2 (p = 0.2037).
  
  
  CONCLUSIONS
  We demonstrate that central apnea in the premature newborn is not a cause of gastroesophageal reflux. However, these patients are more likely to have gastroesophageal reflux in the first days of extrauterine life. It is recommended to exclude pathological gastroesophageal reflux when the newborn presents a clinical scenario compatible with central apnea.
authors.affiliation: Sección de Fisiología Gastrointestinal, Hospital Español de México, DF, Mexico. gerar3d@yahoo.com
authors.forename: Edgardo
authors.initials: E
authors.lastname: Suárez-Morán
authors.forename: Gerardo Alfonso
authors.initials: GA
authors.lastname: Morales-Fuentes
authors.forename: Jesús Alejandro
authors.initials: JA
authors.lastname: Inzunza-González
authors.forename: Ivonne
authors.initials: I
authors.lastname: Cedillo-Ley
authors.forename: Moisés
authors.initials: M
authors.lastname: Gerardo-del Hoyo
authors.forename: Horacio
authors.initials: H
authors.lastname: Silva-Ramírez
mesh_terms: D001919:Bradycardia / Q000150:complications; D016022:Case-Control Studies; D015897:Comorbidity; D050782:Esophageal pH Monitoring; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008800:Mexico; D017286:Polysomnography; D011379:Prognosis; D020182:Sleep Apnea, Central / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D020181:Sleep Apnea, Obstructive / Q000150:complications