Pharmacological Therapy of Gastroesophageal Reflux in Preterm Infants

Abstract

Although gastroesophageal reflux (GER) is a very common phenomenon among preterm infants, its therapeutic management is still an issue of debate among neonatologists. A step-wise approach should be advisable, firstly promoting nonpharmacological interventions and limiting drugs to selected infants unresponsive to the conservative measures or who are suffering from severe GER with clinical complications. Despite of this, a concerning pharmacological overtreatment has been increasingly reported. Most of the antireflux drugs, however, have not been specifically assessed in preterm infants; moreover, serious adverse effects have been noticed in association to their administration. This review mainly aims to draw the state of the art regarding the pharmacological management of GER in preterm infants, analyzing the best piecies of evidence currently available on the most prescribed anti-reflux drugs. Although further trials are required, sodium alginate-based formulations might be considered promising; however, data regarding their safety are still limited. Few piecies of evidence on the efficacy of histamine-2 receptor blockers and proton pump inhibitors in preterm infants with GER are currently available. Nevertheless, a significantly increased risk of necrotizing enterocolitis and infections has been largely reported in association with their use, thereby leading to an unfavorable risk-benefit ratio. The efficacy of metoclopramide in GER's improvement still needs to be clarified. Other prokinetic agents, such as domperidone and erythromycin, have been reported to be ineffective, whereas cisapride has been withdrawn due to its remarkable cardiac adverse effects.

Investigation and management of gastro‐oesophageal reflux in United Kingdom neonatal intensive care units

“…In the 2004 survey, 30% of units used pH monitoring on a regular basis (3). The current survey revealed that still only a minority of units (34%) were using pH monitoring, perhaps reflecting the poor correlation between symptoms and the results of investigations (7) and/or the problems with interpreting the results. Reflex events are diagnosed if there is a reduction in the oesophageal pH below four.…”

Les formes mal connues et/ou trompeuses du reflux gastro-œsophagien depuis l’enfance jusqu’à l’âge adulte

“…Une excellente revue parue en 2013 attire l'attention sur les méfaits de certaines thé-rapeutiques en insistant sur la prudence des décisions [13].…”

Morbidity and Mortality in Preterm Infants following Antacid Use: A Retrospective Audit

“…Antacids such as ranitidine and omeprazole are gastric acid secretion inhibitors and are commonly prescribed to preterm babies across neonatal intensive care units (NICUs) for management of reflux symptoms and GORD despite little evidence for efficacy and safety of their use in this age group [1, 3, 6, 7]. Prescription is in an off-labelled manner in preterm infants due to their perceived safety and possible benefits [3, 8–11].…”

“…Prescription is in an off-labelled manner in preterm infants due to their perceived safety and possible benefits [3, 8–11]. Gastric juice acidity, however, provides a major non-immune defence barrier against infections in neonates [12]; hence the use of gastric inhibitors has been shown in various studies to assist onset of infections in preterm infants and children leading to morbidity and mortality [1, 12–15].…”