Reflujo gastroesofágico ácido y no ácido en el recién nacido. Datos preliminares de estudio con impedancia intraesofágica / Acid and non-acid gastro-esophageal reflux in newborns. Preliminar results using intraluminal impedance

RESUMEN

El reflujo gastroesofágico (RGE) es un hecho muy común en niños pretérmino. La prueba gold standard hasta ahora para medir el reflujo, la pHmetría, se ve limitada en estos niños debido a que supH gástrico es superior a 4 un 90% del tiempo. Nuevos métodos como la impedanciometría, y los catéteres de micromanometría,intentan paliar el déficit existente hasta ahora en este campo. Los objetivos de nuestro estudio son en una primera fase obtener valores normales de impedanciometría en niños controles y estudiar,en una segunda fase, la relación entre RGE y enfermedad respiratoria en recién nacidos pretérmino, con un registro multivariable de impedancia y pH para identificar los episodios de reflujo y las variaciones del electrocardiograma (ECG), la saturación de O2 (SO2), la frecuencia respiratoria (FR) y el CO2 espirado (ETCO2), para objetivar si los episodios de reflujo tienen alguna relación con la enfermedad respiratoria. Hemos estudiado hasta ahora a 7 niños pretérmino, con controles mediante monitorización durante 24 horas de pHmetría + impedancia. Nº de reflujos ácidos 89. Nº de reflujos pH>4 192. Reflujos que llegan a esófago distal 79,36%.La impedancia, por tanto, se trata de un método inocuo que abre nuevos horizontes en el estudio de una enfermedad tan común como el RGE (AU)

ABSTRACT

Preterm infants present often Gastroesophageal refluxes (GER). Esophageal pH monitoring to reflux detection is of limited use in this infants because their gastric pH is normally higher than 4 for 90% of the time. Other methods such as the Intraluminal Impedance Technique (MII) technique and the use of micromanometric catheters try to palliate the difficulties for measuring GER by pH monitoring. The aim of this study, in a first step, was to obtain the normal Intraluminal Impedance values on control children and, in a second step, to study the relationship between GER and cardiorespiratory episodes using simultaneous recording of the end-tidal fraction of expired CO2, O2 saturation by pulse-oximetry, respiratory frequency, esophageal impedance and manometry, gastro-esophageal pHmetry, and electrocardiography in selected patients. Data from simultaneous pH and Intraluminal Impedance during 24 hours in 7 control preterms showed 89 acid refluxes, 192 non-acid refluxes, 79.36% of all refluxes reached the proximal esophagus. Therefore the impedance is an innocuous method which opens new horizons in the study of such a common illness as the GER in the preterm infantsPreterm infants present often Gastroesophageal refluxes(GER). Esophageal pH monitoring to reflux detection is of limited use in this infants because their gastric pH is normally higher than 4 for 90% of the time. Other methods such as the Intraluminal Impedance Technique (MII) technique and the use of micromanometric catheterstry to palliate the difficulties for measuring GER by pH monitoring. The aim of this study, in a first step, was to obtain the normal Intraluminal Impedance values on control children and, in a second step, to study the relationship between GER and cardiorespiratory episodes using simultaneous recording of the end-tidal fraction of expired CO2,O2 saturation by pulse-oximetry, respiratory frequency, esophageal impedance and manometry, gastro-esophageal pHmetry, and electrocardiographyin selected patients. Data from simultaneous pH and Intraluminal Impedance during 24 hours in 7 control preterms showed 89 acid refluxes, 192 non-acid refluxes, 79.36% of all refluxes reached the proximal esophagus.Therefore the impedance is an innocuous method which opens new horizons in the study of such a common illness as the GER in the preterm infants (AU)