Reflux and brachycardia

My son was born on Sept. 11th of this year, about 4-5 weeks early.  He was transported to Johns Hopkins in Baltimore on the same day.  The doctors had said he was just having some apnea and brachycardia and it should clear up not too long from then.  He has had every single test done, 2 MRI's on his brain, a brain scan, they drained spinal fluid and also did an ultra sound.  The only thing they found was a Grade 1 brain bleed, which they said was very common and nothing to worry about, that it would fix itself.  Almost 2 days ago they started him with the 2 medicines to treat him for reflux, zantac and I am not sure of the other one.  He had not had an episode (brady) since Monday of this week until today.  Now they restart the count for another 5-7 days (episode free) before he can come home.  My question is #1 Is this ever going to end, or are they over looking something?  #2 We are growing impatient with all these tests that have been done, if it isn't the reflux what else could it possibly be?  #3 Is this something that will affect him in the long run?

[Yao Sun, MD, PhD]

The physicians at Johns Hopkins are performing the evaluations and treatment that are appropriate for your son.  The most common reasons for premature infants to have "apnea" episodes are immaturity of the brain center that controls breathing, and gastroesophageal reflux.  Your son is old enough that apnea of prematurity is likely to have resolved.  The other investigations (lumbar punctures, MRI, etc.) are appropriate to evaluate for other neurologically based causes of apnea.

To attempt to answer your qeustions:
1) and 2) Some babies continue to have apnea past the expected due date for unknown reasons.  The physicians at Johns Hopkins are performing appropriate assessments and treatments.  They may decide to pursue other less common reasons for apnea if it persists.
3) I cannot tell you whether this is something that will affect him in the long run, as it depends upon the underlying cause for the apnea.  Reflux and apnea of prematurity are not long term problems.  If something else is discovered during the course of evaluating your son, then his physicians should discuss with you what the long term implications are.

I'm sorry that I cannot be more detailed in my responses.  The appropriate evaluation and treatment course for any patient will vary depending upon the individual circumstances for that patient.