Involvement of autonomic nervous activity changes in gastroesophageal reflux in neonates during sleep and wakefulness

  • F. Telliez
    Correspondence
    Corresponding author.
    Affiliations
    PériTox Laboratory (UMR-I 01 Ineris), Health Research University Center-Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
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  • G. Kongolo
    Affiliations
    Neonatal and Pediatric Intensive Care Unit, Amiens University Medical Center, Amiens, France

    GRAMFC (INSERM U 1105), Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
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  • E. Stéphan-Blanchard
    Affiliations
    PériTox Laboratory (UMR-I 01 Ineris), Health Research University Center-Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
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  • M. Ammari
    Affiliations
    PériTox Laboratory (UMR-I 01 Ineris), Health Research University Center-Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
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  • André Léké
    Affiliations
    PériTox Laboratory (UMR-I 01 Ineris), Health Research University Center-Faculty of Medicine, Jules Verne University of Picardy, Amiens, France

    Neonatal and Pediatric Intensive Care Unit, Amiens University Medical Center, Amiens, France
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  • S. Delanaud
    Affiliations
    PériTox Laboratory (UMR-I 01 Ineris), Health Research University Center-Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
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  • V. Bach
    Affiliations
    PériTox Laboratory (UMR-I 01 Ineris), Health Research University Center-Faculty of Medicine, Jules Verne University of Picardy, Amiens, France
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  • D. Djeddi
    Affiliations
    PériTox Laboratory (UMR-I 01 Ineris), Health Research University Center-Faculty of Medicine, Jules Verne University of Picardy, Amiens, France

    Pediatric Gastroenterology Unit, Amiens University Medical Center, Amiens, France
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      Background: It has been suggested that disturbed activity of the autonomic nervous system is one of the factors involved in gastroesophageal reflux (GER) in adults. We sought to establish whether transient ANS dysfunction (as assessed by heart rate variability) is associated with the occurrence of GER events in neonates during sleep and wakefulness. Methods: Nineteen neonates with suspected GER underwent simultaneous, synchronized 12-hour polysomnography and esophageal multichannel impedance-pH monitoring. We compared changes in HRV parameters during three types of periods (control and prior to and during reflux) with respect to the vigilance state. Results: The vigilance state influenced the distribution of GER events (P < 0.001), with 53.4% observed during wakefulness, 37.6% observed during active sleep and only 9% observed during quiet sleep. A significant increase in the sympathovagal ratio (+32%, P = 0.013) was observed in the period immediately prior to reflux (due to a 15% reduction in parasympathetic activity (P = 0.017)), relative to the control period. This phenomenon was observed during both wakefulness and active sleep. Conclusion: Our results showed that GER events were preceded by a vigilance-state-independent decrease in parasympathetic tone. This suggests that a pre-reflux change in ANS activity is one of the factors contributing to the mechanism of reflux GER in neonates.
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