Lansoprazole, Ranitidine, and Metoclopramide

Barney, Cindy K.; Baer, Vickie L.; Scoffield, S H; Lambert, D K; Cook, Mike; Christensen, Robert D.

doi:10.1097/anc.0b013e3181a88358

Cited by 9 publications

(4 citation statements)

References 5 publications

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“…Concern of GERD in neonates is evident by the frequent use of acid suppressive medications (1), and prokinetics (2) that are commonly prescribed to alter gastric acidity or gastro-prokinetic functions. Furthermore, practices in the NICU attribute aero-digestive symptoms to the injurious effects of acid reflux events (ARE).…”

Section: Introductionmentioning

confidence: 99%

Significance of Gastroesophageal Refluxate in Relation to Physical, Chemical, and Spatiotemporal Characteristics in Symptomatic Intensive Care Unit Neonates

et al. 2011

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GERD (gastroesophageal reflux disease) is a frequent consideration in ICU neonates. We tested the hypothesis that symptoms in GERD are dependent on the spatio-temporal and physico-chemical characteristics of reflux events by evaluating the symptom sensitivity index (SSI) and symptom index (SI) in relation to the refluxate characteristics. Thirty symptomatic neonates (30.7±0.8 wk gestation) were evaluated using manometry and pH-Impedance methods. During 704.3 hr of recordings, 2,063 GER (gastroesophageal reflux) were observed; 54% of the GER were associated with symptoms. Defined by physical characteristics, there were 51.3% liquid, 29.1% gas, and 19.6% mixed GER. Defined by chemical characteristics, there were 48.5% acid- and 51.5% non-acid GER. Defined by most proximal extent, 79.2% were supra-UES (upper esophageal sphincter), 20.8% were infra-UES. Higher SSI was noted with pH-only events (P<0.0001 vs. pH-Impedance events). Higher SI was noted with movement symptoms (vs. sensory, P=0.04). In a subset analysis, the frequencies of GER events, acid clearance time, and SSI were all greater in chronic lung disease vs. none (P<0.001). In conclusion, clinical significance of symptoms as measured by SSI and SI and characterization of spatial-temporal-physical-chemical nature of GER events as defined by pH-impedance methods clarifies the definition of GERD.

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Section: Introductionmentioning

confidence: 99%

Significance of Gastroesophageal Refluxate in Relation to Physical, Chemical, and Spatiotemporal Characteristics in Symptomatic Intensive Care Unit Neonates

et al. 2011

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“…Anti-reflux medications, including Histamine-2 receptor antagonists (H2RA) and proton-pump inhibitors (PPI), are unlicensed for use in neonates in the UK and many other countries, 4 though offlabel use is frequently reported. 5 Antacids and other acidsuppressing agents may reduce gastric acidity but anti-reflux medications do not improve signs/symptoms of GORD and their use has been associated with increased risks of adverse outcomes including necrotising enterocolitis (NEC) and infections. 6 The North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and European Society for Paediatric Gastroenterology Hepatology and Nutrition (NASPGHAN and ESPGHAN combined) clinical practice guidelines 1 suggests nonpharmacological approaches to GORD before pharmacological therapy.…”

Section: Introductionmentioning

confidence: 99%

Anti-reflux medication use in preterm infants

et al. 2021

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Background Current recommendations do not support the use of anti-reflux medications to treat gastro-oesophageal reflux disease (GORD) among preterm infants. Objective To describe the prevalence of GORD and the use of anti-reflux medications amongst very preterm infants (<32 weeks’ gestational age (GA)) in neonatal units in England and Wales. Design Retrospective cohort study using the National Neonatal Research Database. Results Among 58,108 infants [median GA (IQR) 29 (27–30) weeks], 15.8% (n = 9191) had a diagnosis of GORD and 36.9% (n = 12,446) received anti-reflux medications. Those who received anti-reflux medications were more preterm [GA, median (IQR): medications, 28 (26–30) vs. no medications, 30 (28–31); p < 0.001] and had lower birth weight [mean (SD): medications, 1124 g (354) vs. no medications, 1265 g (384); p < 0.001]. Most (57%, n = 12,224) received Gaviscon, or Histamine-2 Receptor Antagonist (H2RA) (56%, n = 11,959). Over time, prokinetic use has declined substantially, the use of H2RAs and Gaviscon has reduced although they continue to be used frequently, whilst the use of PPIs has increased. Conclusions Anti-reflux medications are frequently prescribed in very preterm infants, despite evidence to suggest that they are not effective and may be harmful. Clear guidelines for diagnosing GORD and the use of anti-reflux medications are required to rationalise the pharmacological management of GORD in preterm infants. Impact Anti-reflux medications are frequently prescribed, often without a diagnosis of gastro-oesophageal reflux disease, to very preterm infants while in the neonatal unit and at discharge. Half of the infants born at <28 weeks’ gestational age receive anti-reflux medications in hospital and a quarter are discharged home on them. Although the use of prokinetics declined following alerts of adverse events, histamine2-receptor antagonists and alginates such as Gaviscon continue to be used and the use of proton-pump inhibitors has increased more than 2-fold.

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“…Histamine-2 receptor antagonists (H 2 RA) are often prescribed off-label to neonates admitted to neonatal intensive care units (NICU) [1] for prophylaxis or therapy of stress ulcers and gastroesophageal reflux disease (GERD). However, the safety and efficacy of H 2 RA in neonates is still debated [2].…”

Section: Introductionmentioning

confidence: 99%

Association between histamine-2 receptor antagonists and adverse outcomes in neonates: A systematic review and meta-analysis

et al. 2019

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Background The use of histamine-2 receptor antagonists (H 2 RA) in neonates is still debated because of possible risk of infection, necrotizing enterocolitis (NEC) and increased mortality. Aim To review whether the use of H 2 RA in neonates admitted to neonatal intensive care units (NICU) is associated with infection, NEC or mortality. Materials and method We performed a systematic search in PubMed, Web of Science and SCOPUS databases using the terms “histamine-2 receptor antagonists”, “infection”, “necrotizing enterocolitis”, “mortality”, “neonates” and related terms to identify studies published up to April 30, 2017. We included studies conducted in hospitalized neonates and exposed to H 2 RA. The primary outcomes were infection, NEC and mortality. We included reports of infections with clinical signs and positive culture, and NEC according to Bell stages (stage ≥II) based on standardised clinical and radiologic criteria. Among 1,144 studies identified, 10 fulfilled the selection criteria. Information extracted included study design, sample size and number of participants, along with the outcomes of interest. We conducted a meta-analysis of adjusted data and pooled estimates of infection, NEC and mortality are reported as odds ratios (OR) and 95% confidence intervals (95%CI). Results Ten studies were analysed. There were substantial associations between H 2 RA and infection (pooled OR: 2.09; 95%CI: 1.35–3.24; P = 0.001) and NEC (pooled OR: 2.81, 95%CI: 1.19–6.64; P = 0.02) but not with the mortality risk (pooled OR: 1.76; 95%CI: 0.50–6.16; P: 0.38). Conclusion Current evidence suggests that H 2 RA is associated with an increased risk of infection and NEC, but not with mortality in neonates admitted to NICU. The use of H 2 RA in neonates must be stringently considered when necessary.

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Lansoprazole, Ranitidine, and Metoclopramide

Abstract: The extreme variability among the centers in use patterns of these 3 medications suggests lack of an adequate evidence base to guide practice and indicates that case controlled studies or random controlled trials are needed to devise a consistent evidence-based approach.

Cited by 9 publications

References 5 publications

Significance of Gastroesophageal Refluxate in Relation to Physical, Chemical, and Spatiotemporal Characteristics in Symptomatic Intensive Care Unit Neonates

Significance of Gastroesophageal Refluxate in Relation to Physical, Chemical, and Spatiotemporal Characteristics in Symptomatic Intensive Care Unit Neonates

Anti-reflux medication use in preterm infants

Association between histamine-2 receptor antagonists and adverse outcomes in neonates: A systematic review and meta-analysis

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