Conference Coverage

Acid blockers boost infections in outpatient preemies


 

AT THE PAS ANNUAL MEETING

References

BALTIMORE – Treatment of premature infants with a drug that blocks gastroesophageal reflux once they are discharged home during the first year of life was associated with a significantly increased risk for development of pneumonia and gastroenteritis in a case-control study with 695 matched-pairs of infants.

Administering either a histamine2-receptor antagonist or proton pump inhibitor to these children was associated with an adjusted 75% increased risk for pneumonia and a 2.4-fold increased risk for gastroenteritis during the periods when the infants were on these acid-blocking drugs, Dr. Scott A. Lorch said at the annual meeting of the Pediatric Academic Societies. However, these medications did not appear to produce any lingering effects, with the rates of these infections falling to match control rates after acid-blocking treatment ceased.

Dr. Scott A. Lorch Mitchel L. Zoler/Frontline Medical News

Dr. Scott A. Lorch

The findings highlight that acid-blocking drugs “are not without consequences” and so should be “carefully considered before initiating therapy in this medically fragile population [premature infants], and if they are prescribed their continued need should be frequently assessed,” said Dr. Lorch, a neonatologist at the Children’s Hospital of Philadelphia.

In his experience, acid blockers “are being used like water, both in the hospital as well as after the infants go home. That is where there is concern. We see a fair number of kids on these medications for a much longer period of time than you’d expect. The average time on these medications is 6 months, and that is a long time to be on them,” Dr. Lorch said.

He noted that study results reported in 2015 by himself and his associates showed that in the 30-site primary care network affiliated with the Children’s Hospital of Philadelphia, three-quarters of the acid-blocking drug prescriptions written for infants who had been born prematurely came from primary care physicians once the infants had been discharged from the hospital.

The current study used data that had been collected on more than 2,000 infants who had been born at less than 36 weeks’ gestation during 2007-2009 and then discharged within 4 months of delivery into care by the primary care network and then followed until they were 3 years old. From this cohort, the researchers identified 695 infants who began treatment with either a histamine2-receptor antagonist or a proton pump inhibitor at some time during their first year and matched them by gestational age at birth and race with an equal number of infants from the cohort who never received an acid-blocking drug.

Dr. Lorch and his associates then analyzed the incidence rates of four different types of infections in the children during three time periods: while they were on the acid-blocking medication, and at 7 months and 13 months after the acid-blocking treatment stopped. Infection rates in the controls were tallied at ages that matched the periods studied in those who received the acid blockers.

The four infections they studied were pneumonia, gastroenteritis, bronchiolitis, and conjunctivitis. The last was included as a control as the researchers presumed that acid-blocker use should have no impact on the rates of conjunctivitis.

The results showed that during acid-blocker treatment, the incidence rate of pneumonia was 5% in those on an acid blocker and 3% in the controls, and the incidence of gastroenteritis was 19% in those on an acid blocker and 12% in the controls, Dr. Lorch reported. However, the rates of both infections were similar at 7 and 13 months after acid-blocker treatment stopped, and there was also no difference in the rates of both bronchiolitis and conjunctivitis during any period examined.

A multivariate analysis that controlled for a variety of clinical and demographic variables determined the 75% increased odds ratio for pneumonia and the 2.4-fold increased rate of gastroenteritis, compared with the controls, during periods of acid-blocker treatment. The analysis also showed that the presence of chronic lung disease appeared to have no impact on these infection rates.

Dr. Lorch had no relevant financial disclosures.

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On Twitter @mitchelzoler

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