Objective Gastroesophageal reflux (GER) and apnea of prematurity (AOP) are events that commonly occur in preterm infants. Our recent data highlight an increase of AOP in periods after GER. The aim of the study was to evaluate efficacy of sodium-alginate in reducing frequency of AOP related to GER in preterm infants.

Methods Twelve infants (GA:28+3 wks; BW:1124 g) were studied as they had recurrent apneas. They underwent a simultaneous polysomnography and pH-impedance monitoring (pH-MII). Polysomnography characterizes apneas, by recording of breathing movement, nasal airflow, electrocardiogram, pulse oximeter saturation and videoregistration. Respiratory pauses lasting more than 5 seconds were considered. By pH-MII monitoring we registered acid/non acid GERs. GER and AOP were considered temporally related if both started within 30 s of each other. Each registration involved 2 post-prandial periods lasting 3 hours characterized by presence or absence of treatment with sodium alginate (2 cc/kg) after meal. Data registered during the two post-prandial periods (with or without treatment) were compared.

Results During the 72 h of registration we found 373 AOP and 385 GER events. Comparing data found after treatment with those registered during free-treatment periods we found no differences in number of total apneas and related events. Reduction in the number of GERs after using sodium alginate was observed, mostly related to acid episodes.

Conclusions Preliminary data suggest that sodium-alginate reduces number of GERs, in particular acid ones, but not significantly. We observed that frequency of AOP events do not change after treatment with sodium alginate. These data can be explained by poor efficacy in reducing non-acid GERs, particularly relevant in preterm infants.