The frequency of diuretic administration to infants with BPD at US children's hospitals, as well as the specific diuretic regimen used, varies markedly by institution. Safety and effectiveness research of long-term diuretic therapy for BPD patients is needed to develop evidence-based recommendations.

OBJECTIVE To determine the practice variance, prevalence, and economic burden of clinically diagnosed gastroesophageal reflux disease (GERD) in preterm infants. METHODS Applying a retrospective cohort study design, we analyzed data from 18 567 preterm infants of 22 to 36 weeks’ gestation and > 400 g birth weight from the NICUs of 33 freestanding children’s hospitals in the United States. GERD prevalence, comorbidities, and demographic factors were examined for their association with average length of stay (LOS) and hospitalization cost. RESULTS Overall, 10.3% of infants received a diagnosis of GERD (95% confidence interval [CI]: 9.8–10.7). There was a 13-fold variation in GERD rates across hospitals (P < .001). GERD diagnosis was significantly (P < .05) associated with bronchopulmonary dysplasia and necrotizing enterocolitis, as well as congenital anomalies and decreased birth weight. GERD diagnosis was associated with $70 489 (95% CI: 62 184–78 794) additional costs per discharge and 29.9 additional days in LOS (95% CI: 27.3–32.5). CONCLUSIONS One in 10 of these premature NICU infants were diagnosed with GERD, which is associated with substantially increased LOS and elevated costs. Better diagnostic and management strategies are needed to evaluate reflux-type symptoms in this vulnerable NICU population.

Objective To determine treatment frequency and duration of H2RA/PPI use among infants hospitalized within US children’s hospital NICUs and evaluate diagnoses/demographic factors associated with use. Study design We retrospectively analyzed a cohort of NICU infants admitted to 43 US children’s hospitals within the Pediatric Health Information System (PHIS) database between January 2006-March 2013 to determine H2RA/PPI treatment frequency, timing/duration of treatment, factors associated with use, percent of infants remaining on treatment at discharge, and inter-hospital prescribing variation. We used a modified Poisson regression to calculate the adjusted probability of infants ever receiving H2RAs/PPIs in relation to diagnosis, gestation, and sex. Results Of the 122,002 infants evaluated, 23.8% (n=28,989) ever received an H2RA or PPI; 19.0% received H2RAs (n=23187) and 10.5% (n=12823) received PPIs. Extremely preterm infants and term infants were the most likely to receive H2RA and PPI treatment. Infants with GERD [relative risk (RR): 3.13] and congenital heart disease (RR=2.41) had the highest H2RA/PPI treatment probabilities followed by those with an ENT diagnoses (RR=2.34; p<0.05). The majority of treated infants remained treated at discharge. Conclusion Despite limited evidence and increasing safety concerns, H2RAs/PPIs are frequently prescribed to extremely preterm neonates and those with congenital anomalies and continued through discharge. Our findings support the need for innovative studies to examine the comparative effectiveness and safety of H2RA/PPIs versus no treatment in these high-risk neonatal populations.