Environmental tobacco smoke exposure and gastroesophageal reflux in infants with apparent life-threatening events

Abstract

Objective: To study the hypothesis that environmental tobacco smoke exposure in infants diagnosed with an apparent life-threatening event (ALTE) could be a contributing factor to gastroesophageal reflux.

Methods: Thirty-four polygraphic recordings of combined esophageal pH study and respiration in infants with ALTE, age 4.1 +/- 4.9 months, range 0.4-27 months, were studied. This group of children had uncomplicated perinatal history, no congenital anomalies, no neuropathology, and no drug exposure. A written questionnaire was administered to the parents to determine the following: environmental variables, degree of environmental tobacco smoke (ETS) exposure (number of cigarettes/day), and nutrition (breast vs. bottle feeding).

Results: There was a strong correlation between pH study parameters and ETS exposure (p < 0.005). The esophageal pH parameters were markedly elevated in the ETS-exposed group and in this group there was a linear relation between the number of cigarettes smoked per day and reflux index, as well as reflux > 5 min/hr (p < 0.05, r = 0.46). Nursing mothers were less likely to be smokers (18.2% vs. 34.0%). The only significant respiratory finding was in the obstructive/mixed apnea group; there was strong association between ETS exposure and high reflux index (p < 0.05).

Conclusion: We conclude that ETS exposure represents a significant contributing factor to GER. Pediatricians should systematically ask questions about the infant environment, explain the risk of ETS exposure to the caretaker, and recommend that children should remain in a smoke-free environment.