technetium-tc-99m-sulfur-colloid and Apnea

It has been suggested that gastroesophageal reflux scintigraphy (GRS) might be useful in assisting one in determining therapy for patients suspected of aspirating or becoming apneic secondary to gastroesophageal reflux. This, however, has not been our experience and in reviewing 23 patients with recurrent pneumonia and/or apnea who had GRS, we were able to detect aspiration in only one. This was especially significant since 13 (59%) of these patients had demonstrable reflux, and of these, eight were treated successfully for suspected aspiration even though none was demonstrated isotopically. To be sure, the demonstration of pulmonary aspiration with GRS had little influence on patient selection and response to therapy. For this reason we feel there is little justification in depending on the GRS for the specific purpose of trying to document pulmonary aspiration in infants and children who are refluxing.

Topics: Apnea; Child, Preschool; Evaluation Studies as Topic; Gastroesophageal Reflux; Humans; Image Processing, Computer-Assisted; Infant; Infant, Newborn; Pneumonia, Aspiration; Radionuclide Imaging; Recurrence; Retrospective Studies; Technetium Tc 99m Sulfur Colloid

Scintigraphic studies of swallowed 99m Tc-sulphur colloid mixed with a few millilitres of liquid, performed on 400 paediatric patients of all ages, allowed visualisation of foregut function and measurement of oesophageal transit time and gastric emptying proportions. This non-invasive and physiological procedure requires a standard gamma camera with computing facilities and was performed as an outpatient routine. It proved very effective for the detection of gastro-oesophageal reflux and aspiration of refluxed liquid in patients of all ages but especially in neonates. The relevance of these scintigraphic results to oesophagitis, repeated respiratory problems, cyanotic and apnoeic spells and alternative methods of investigation is described.

Topics: Apnea; Esophagitis, Peptic; Female; Gastric Emptying; Gastrointestinal Motility; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Pneumonia, Aspiration; Radionuclide Imaging; Respiration Disorders; Sudden Infant Death; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid