title: Adverse outcomes associated with gastroesophageal reflux disease are rare following an apparent life-threatening event.
abstract: OBJECTIVE
  To evaluate for adverse outcomes associated with gastroesophageal reflux disease (GERD) following an apparent life-threatening event (ALTE) and potential risk factors of these outcomes.
  
  
  METHODS
  Retrospective cohort study of well-appearing infants (<12 months) admitted for ALTE. Patients were followed for adverse outcomes associated with GERD (including aspiration pneumonia, failure-to-thrive, or anti-reflux surgery), second ALTE, or death. Risk factors evaluated included: age, prematurity, gender, previous event, diagnosis of GERD, gastrointestinal (GI) testing positive for gastroesophageal reflux, length of stay (LOS), and neurologic impairment diagnosed in follow-up.
  
  
  RESULTS
  Four hundred sixty-nine patients met inclusion criteria, mean age was 45 days, 110 (22%) were premature. Patients were followed for an average of 7.8 years; 3.8% of all patients had an adverse outcome associated with GERD. The only significant risk factors were a longer LOS, and development of neurological impairment. A diagnosis of GERD and positive reflux testing during the initial hospitalization were not associated with adverse outcomes associated with GERD.
  
  
  CONCLUSIONS
  Adverse outcomes associated with GERD are rare following an ALTE. Patients who developed neurological impairment and a longer initial LOS were at higher risk for developing these outcomes. Positive testing for gastroesophageal reflux during hospitalization for ALTE did not predict adverse outcomes associated with GERD.
authors.affiliation: Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA. gabrielle.zimbric@hsc.utah.edu
authors.forename: Gabrielle
authors.initials: G
authors.lastname: Zimbric
authors.forename: Joshua L
authors.initials: JL
authors.lastname: Bonkowsky
authors.forename: W Daniel
authors.initials: WD
authors.lastname: Jackson
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Maloney
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
mesh_terms: D017677:Age Distribution; D005183:Failure to Thrive / Q000209:etiology; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000706:statistics & numerical data; D005764:Gastroesophageal Reflux / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007902:Length of Stay; D009422:Nervous System Diseases; D017063:Outcome Assessment, Health Care; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011015:Pneumonia, Aspiration / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D014589:Utah