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Duration of H2RA/PPI Use Among Hospitalized Infants

J Pediatr; ePub 2016 Apr 27; Slaughter, Stenger, et al

Publish date:: May 10, 2016

Histaimine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) are frequently prescribed to extremely preterm neonates and those with congenital anomalies and continued through discharge, despite limited evidence and increasing safety concerns. This according to a study of 122,002 infants; 23.8% ever received an H2RA or PPI, and 19.0% received H2RAs, and 10.5% received PPIs. Researchers found:

• Extremely preterm infants and term infants were the most likely to receive H2RA and PPI treatment.

• Infants with gastroesophageal reflux disease (RR=3.13) and congenital heart disease (RR=2.41) had the highest H2RA/PPI treatment probabilities followed by those with an ear, nose, and throat diagnosis (RR=2.34).

• The majority of treated infants remained treated at discharge.

Citation: Slaughter JL, Stenger MR, Reagan PB, Jadcherla SR. Neonatal histamine-2 receptor antagonist and proton pump inhibitor treatment at United States children’s hospitals. [Published online ahead of print April 27, 2016]. J Pediatr. doi:http://dx.doi.org/10.1016/j.jpeds.2016.03.059.

Commentary: It is astonishing to see that almost a quarter of infants studied have received PPIs or H2RAs. This is in the context of guidelines that have recommended judicious use of acid-suppressive therapy in infants and children due to the paucity of data around efficacy and the significant evidence of potential risk.¹ The use of acid-suppressive therapy in neonates has been associated with infections such as C. diff enterocolitis, pneumonia, necrotizing enterocolitis, and even increased mortality risk.² This study serves as a reminder to regularly examine our practice patterns to see if they fit the current evidence. —Neil Skolnik, MD

1. Vandenplas Y, Rudolph CD, Di Lorenzo C, Hassall E, Liptak G, Mazur L, et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr. 2009;49:498-547. doi:10.1097/MPG.0b013e3181b7f563.

2. Herzig SJ, Howell MD, Ngo LH, Marcantonio ER. Acid-suppressive medication use and the risk for hospital-acquired pneumonia. JAMA. 2009;301:2120-8. doi:10.1001/jama.2009.722.

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