Abstract

This review article discusses some of the challenges associated with the interpretation of esophageal pH monitoring as part of multichannel pneumogram in neonates with suspected gastroesophageal reflux and cardiorespiratory symptoms such as recurrent apnea, bradycardia and desaturations and chronic lung disease. Several of the early studies have suggested an association between GER and apnea in preterm and term infants and this has contributed to widespread use of antireflux medications in the treatment of apnea of prematurity and infants with chronic lung disease. Despite recent studies showing no temporal or causal relationship between GER and apnea or chronic lung disease referrals from pediatricians and neonatologists in community hospitals for esophageal pH monitoring as part of multichannel pneumogram remain relevant today in the Neonatal Intensive Care Units (NICU). Interpretation of esophageal pH monitoring is particularly challenging in preterm infants because of the lack of published normative data. The reflux index (RI), which represents the percentage of the total time esophageal pH<4 is the most widely used discriminator between acid and nonacid reflux. Several factors may influence the results and this article aims to highlight some of the limitations and pitfalls of this diagnostic technique.

Keywords: Gastroesophageal reflux (GER); Gastroesophageal reflux disease (GERD); Transient lower esophageal sphincter relaxation (TLESR); Electrocardiogram (EKG); Heart rate (HR); Pulse oximetry (SpO2); Reflux index (RI)