The use of fundoplication for prevention of apparent life-threatening events



      Gastroesophageal reflux disease (GERD) is cited by many to be a common cause of apparent life-threatening events (ALTEs). However, there are few reports in the literature regarding the surgical treatment of GERD to prevent a recurrent ALTE.


      A retrospective review of infants undergoing fundoplication between 2000 and 2005 for the prevention of another ALTE was undertaken. Preoperative, operative, and postoperative data as well as follow-up information were collected.


      During the study period, 81 patients underwent fundoplication after presenting with an ALTE. All but 3 patients (96.3%) had been treated with antireflux medication. Moreover, 71 infants (87.7%) were taking antireflux medication at the time of their ALTE. A significant number of infants (77.8%) were hospitalized with a second ALTE before referral for fundoplication. After fundoplication, only 3 patients (3.7%) experienced a recurrent ALTE during the follow-up period; 2 required a second fundoplication and 1 underwent pyloromyotomy. None of these 3 patients have experienced a recurrent ALTE after the second operation. The median follow-up has been 1738 days.


      Our data suggest that among patients who had an ALTE and are found to have GERD, fundoplication appears to be an effective method for preventing recurrent ALTE.

      Index words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. National Institutes of Health Consensus Development Conference on Infantile apnea and home monitoring.
        Pediatrics. 1987; 79: 292-299
        • Herbst J.
        • Minton S.
        • Book L.
        Gastroesophageal reflux causing respiratory distress and apnea in newborn infants.
        J Pediatr. 1979; 95: 763-768
        • Menon A.
        • Schefft G.
        • Thach B.
        Apnea associated with regurgitation in infants.
        J Pediatr. 1985; 106: 625-629
        • Spitzer A.
        • Boyle J.
        • Tachman D.
        • et al.
        Awake apnea associated with gastroesophageal reflux: a specific clinical syndrome.
        J Pediatr. 1984; 104: 200-205
        • Sacre L.
        • Vandenplas Y.
        Gastroesophageal reflux associated with respiratory abnormalities during sleep.
        J Pediatr Gastroenterol Nutr. 1989; 9: 28-33
        • Kurz R.
        • Kenner T.
        • Reiterer T.
        • et al.
        Factors involved in the pathogenesis of unexpected near miss events of infants (ALTE).
        Acta Pediatr Hung. 1990; 30: 435-437
        • Veereman-Wauters G.
        • Bochner A.
        • Van Caillie-Bertrand M.
        Gastroesophageal reflux in infants with a history of near-miss sudden infant death.
        J Pediatr Gastroenterol Nutr. 1991; 12: 319-323
        • Tsukada K.
        • Kosuge N.
        • Hosokawa M.
        • et al.
        Etiology of 19 infants with apparent life-threatening events: relationship between apnea and esophageal dysfunction.
        Acta Paediatr Jpn. 1993; 35: 306-310
        • McMurray J.S.
        • Holinger L.D.
        Otolaryngic manifestations in children presenting with apparent life-threatening events.
        Otolaryngol Head Neck Surg. 1997; 116: 575-579
        • Nunes M.L.
        • Costa J.C.
        • Ferreira C.P.
        • et al.
        Associated and prognosis in apparent life threatening events.
        J Pediatr (Rio J). 1999; 75: 55-58
        • Davies F.
        • Gupta R.
        Apparent life threatening events in infants presenting to an emergency department.
        Emerg Med J. 2002; 19: 11-16
        • McGovern M.C.
        • Smith M.B.H.
        Causes of apparent life threatening events in infants: a systematic review.
        Arch Dis Child. 2004; 89: 1043-1048
        • DeWolfe C.C.
        Apparent life-threatening event: a review.
        Pediatr Clin North Am. 2005; 52: 1127-1146
        • Hall K.L.
        • Zalman B.
        Evaluation and management of apparent life-threatening events in children.
        Am Fam Physician. 2005; 71: 2301-2308
        • Kahn A.
        Recommended clinical evaluation of infants with an apparent life-threatening event. Consensus document of the European Society for the Study and Prevention of Infant Death, 2003.
        Eur J Pediatr. 2004; 163: 108-115
        • Schier F.
        Indications for laparoscopic antireflux procedures in children.
        Semin Laparosc Surg. 2002; 9: 139-145
        • Kiechl-Kohlendorfer U.
        • Hof D.
        • Pupp Peglow U.
        • et al.
        Epidemiology of apparent life threatening events.
        Arch Dis Child. 2005; 90: 297-300
        • Tirosh E.
        • Kessel A.
        • Jaffe M.
        • et al.
        Outcome of idiopathic apparent life-threatening events: infant and mother perspectives.
        Pediatr Pulmonol. 1999; 28: 47-52
        • Thach B.T.
        Reflux associated apnea in infants: evidence for a laryngeal chemoreflex.
        Am J Med. 1997; 103: 120S-124S
        • Bauman N.M.
        • Sandler A.D.
        • Schmidt C.T.
        • et al.
        Reflex laryngospasm induced by stimulation of distal esophageal afferents.
        Laryngoscope. 1994; 104: 209-214
        • Herbst J.J.
        • Minton S.D.
        • Book L.S.
        Gastroesophageal reflux causing respiratory distress and apnea in newborn infants.
        J Pediatr. 1979; 95: 763-768