Gastroesophageal reflux in infants with a history of near-miss sudden infant death.

From January 1984 through August 1986, 130 infants were referred to our department with a history of apnea, hypotonia, and cyanosis or pallor, suggesting near-miss sudden infant death syndrome. Protocol consisted of medical history, clinical examination, overnight polygraphic recording, and cardiologic, gastrointestinal, metabolic, neurologic, and toxicologic workups. In 49 of these infants who needed vigorous stimulation or mouth to mouth resuscitation, the event occurred shortly after feeding. Combined, continuous esophageal pH monitoring and polygraphic recording in these 49 infants showed pathologic gastroesophageal reflux (GER) in 34 patients. An abnormal overnight polygraphic recording was observed in 8 of 34 infants with pathologic GER. Other investigations led to etiologic diagnoses in 42 of the remaining infants. Severe GER was frequently found in children with apnea after feeding but clearly is not the only mechanism involved. Infants with a history of apnea after a feeding should be investigated for GER and appropriately treated.