Antacid therapy for gastroesophageal reflux in preterm infants: a systematic review

Abstract

BackgroundGastro-oesophageal reflux is prevalent in preterm infants. Despite widespread use in clinical practice, there is still much controversy over the efficacy and safety of drug interventions, particularly antacid therapy.ObjectiveTo systematically review the effects of antacid therapy on preterm infants with symptoms of gastro-oesophageal reflux, and to assess the safety of these interventions.MethodsWe carried out an electronic search of the Cochrane central register of controlled trials (CENTRAL, The Cochrane Library), MEDLINE (1966–present), EMBASE (1980–present) and CINAHL (1982–present) as well as other online sources. Participants were preterm infants (<37 weeks gestation) with gastro-oesophageal reflux disease who were receiving care on a neonatal unit. We assessed the effects of histamine-2 receptor antagonists, proton pump inhibitors and alginates against placebo, primarily to see if they reduced the symptoms of reflux.ResultsSix studies were included in this review. Meta-analysis could not be carried out due to a lack of studies assessing the same intervention with the same outcomes. Omeprazole therapy significantly reduced the oesophageal acid exposure percentage time with pH<4 (p<0.01) and sodium alginate significantly decreased gastro-oesophageal reflux episodes (p=0.024). Metoclopramide and ranitidine showed a significant increase in gastro-oesophageal reflux disease symptoms versus placebo (p<0.04). No significant results were found for the use of esomeprazole or lansoprazole versus placebo.ConclusionsThere is insufficient evidence available to conclude whether antacid therapy is effective or safe when treating gastro-oesophageal reflux disease in preterm infants. Further research is needed into this topic and caution should be taken when administering antacids to preterm infants.Trial registration numberCRD42017078778

Effects of Lactobacillus reuteri DSM 17938 in preterm infants: a double-blinded randomized controlled study

“…GOR is a prominent condition among preterm infants. Symptoms such as apnoea, bradycardia, vomiting, poor weight gain and irritability have been attributable to GOR, which is called gastroesophageal reflux disease (GORD), when symptoms are severe [15]. Experimental data showed that L. reuteri can promote gastric motility, accelerate gastric emptying, promote colonic peristalsis, and reduce the incidence of dyspepsia and reflux [16, 17].…”

Rational Use of Medicines in Neonates: Current Observations, Areas for Research and Perspectives

“…Medicines utilization research informs us on trends, on between unit variability and on the impact of guideline implementation. This utilization research is not limited to exposure to antibiotics [ 4 , 9 , 10 , 11 , 12 , 13 , 14 , 20 ], but has been illustrated using data on drugs for gastroesophageal reflux, analgesics or anti-epileptic drugs [ 4 , 17 , 18 , 19 , 20 , 21 ]. We hereby illustrate how a shift in practices can result in another irrational practice with another compound (shift from prokinetics to anti-acid drugs to treat reflux associated-apnea).…”

“…This occurred despite the lack of evidence that gastric acid reducing drugs are effective to reduce gastric acid production, reflux and apnea. More recently and following this shift, there was also emerging evidence on relevant harm (higher incidence of necrotizing enterocolitis or late onset sepsis) [ 17 , 19 ].…”

Effect of Right Position During and After Feeding on Gastric Residual Volume and Regurgitation Episodes Among Preterm Infants

“…When regurgitation occurs it is recommended to sit upright or raise the head of the preterm during the feeding and for at least 60 minutes after feeding (McGill-Vargas & Ilg, 2018). Symptoms such as vomiting, poor weight gain, intolerance and irritability have been attributable to regurgitation in preterm infants (Dermyshi, Mackie, Kigozi, Schoonakker & Dorling, 2018). Dermyshi, etal.…”