sodium-bicarbonate and Diseases-in-Twins

The possible pathophysiology of the relationship between gastro-esophageal reflux disease and apnea of prematurity has been widely investigated. Various physiological protective reflex responses provide a plausible biological link between gastro-esophageal reflux and apnea of prematurity. It is uncertain whether or not there is a causal relationship between the two diseases. PATIENT'S FINDINGS: Twins were admitted to the neonatal intensive care unit due to feeding problems. Physical examination was normal except for reticulated, blueviolet skin changes. Short apneic attacks occurred on the first day in twin 1 and on the second day in twin 2, and these were initially treated by stimulation and increased ambient O2 concentration. Then, we conducted methylxanthine and continuous positive airway pressure treatment. Laboratory and radiological analysis were normal. As gastro-esophageal reflux disease was thought to be the causes of the treatment-refractory apnea, therapy with gaviscon and domperidon was begun for both cases. Apneic attacks did not recur after gaviscon and domperidon therapy.. Pharmacological therapy for gastro-esophageal reflux disease has not definitively been shown to be effective in improving symptoms and hence, should be reserved especially for infants with treatment refractory apnea episodes suspected as being gastro-esophageal reflux in premature infants.. 背景：胃食管反流病和早产儿呼吸暂停之间可能的病理生理学机制已被广泛 研究。多种生理保护性反射应答为胃食管反流和早产儿呼吸暂停提供了一个合 理的生物学联系，但二者之间是否存在因果关系尚不确定。患者的研究结 果：双胞胎因为喂养问题被送进新生儿重症监护病房，体格检查发现除了网 状蓝紫色皮肤改变，其它正常。双胞胎1 和双胞胎2 分别在第一天和第二天发 生了短暂的呼吸暂停。最初我们采用刺激和增加环境中氧气浓度来治疗，然后 进行了甲基黄嘌呤和持续气道正压通气治疗。实验室和影像学分析均正常。因 为胃食管反流被认为是难治性呼吸暂停的原因，开始用嘉胃斯康 和 多潘立酮 治疗这两种情况，嘉胃斯康 和 多潘立酮治疗后没有再发生窒息。结论：胃食 管反流病的药物治疗没有明确被证明能有效改善症状，因此，尤其在治疗难治 性呼吸暂停疑似有胃食管反流的早产儿时应谨慎。.

Topics: Alginates; Aluminum Hydroxide; Antacids; Antiemetics; Apnea; Diseases in Twins; Domperidone; Drug Combinations; Gastroesophageal Reflux; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Silicic Acid; Sodium Bicarbonate; Twins