National Study of Off‐label Proton Pump Inhibitor Use Among New Zealand Infants in the First Year of Life (2005–2012)

Blank, Mei‐Ling; Parkin, Lianne

doi:10.1097/mpg.0000000000001596

Cited by 44 publications

(35 citation statements)

References 8 publications

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“…In the USA, the rate was almost four times higher in 2005 than in 200031 and in New Zealand from 2005 to 2012, dispensing rates of PPIs for infants more than doubled, from 2.4% to 5.2%, as did the number of practitioners prescribing PPIs for infants 29. It is possible that the pressure to prescribe acid suppressants may have contributed to a shift in diagnosis from reflux to GORD, seen in the corresponding decline in rates of diagnosis of reflux.…”

Section: Discussionmentioning

confidence: 98%

Acid suppressants for managing gastro-oesophageal reflux and gastro-oesophageal reflux disease in infants: a national survey

et al. 2018

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Overprescribing of acid suppressants to infants may be occurring. In infants, acid-suppressant medicines are no better than placebo and may have significant negative side effects; however, guidelines are inconsistent. Clear, concise and consistent guidance is needed. GPs and parents need to understand what is normal and limitations of medical therapy. We need a greater understanding of the influences on GP prescribing practices, of parents' knowledge and attitudes and of the pressures on parents of infants with these conditions.

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Section: Discussionmentioning

confidence: 98%

Acid suppressants for managing gastro-oesophageal reflux and gastro-oesophageal reflux disease in infants: a national survey

et al. 2018

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“…We found few systematic reviews assessing the effectiveness of PPIs for colic despite their increasing use in this population 21 44. This is because most studies investigating the use of PPIs were for GORD with symptoms of colic.…”

Section: Discussionmentioning

confidence: 99%

Comparison of common interventions for the treatment of infantile colic: a systematic review of reviews and guidelines

2020

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ObjectiveTo conduct a systematic review of systematic reviews and national guidelines to assess the effectiveness of four treatment approaches (manual therapy, probiotics, proton pump inhibitors and simethicone) on colic symptoms including infant crying time, sleep distress and adverse events.MethodsWe searched PubMed, Embase, Cochrane and Mantis for studies published between 2009 and 2019. Inclusion criteria were systematic reviews and guidelines that used evidence and expert panel opinion. Three reviewers independently selected articles by title, abstract and full paper review. Data were extracted by one reviewer and checked by a second. Selected studies were assessed for quality using modified standardised checklists by two authors. Meta-analysed data for our outcomes of interest were extracted and narrative conclusions were assessed.ResultsThirty-two studies were selected. High-level evidence showed that probiotics were most effective for reducing crying time in breastfed infants (range −25 min to −65 min over 24 hours). Manual therapies had moderate to low-quality evidence showing reduced crying time (range −33 min to −76 min per 24 hours). Simethicone had moderate to low evidence showing no benefit or negative effect. One meta-analysis did not support the use of proton pump inhibitors for reducing crying time and fussing. Three national guidelines unanimously recommended the use of education, parental reassurance, advice and guidance and clinical evaluation of mother and baby. Consensus on other advice and treatments did not exist.ConclusionsThe strongest evidence for the treatment of colic was probiotics for breastfed infants, followed by weaker but favourable evidence for manual therapy indicated by crying time. Both forms of treatment carried a low risk of serious adverse events. The guidance reviewed did not reflect these findings.PROSPERO registration numberCRD42019139074.

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“…Despite the lack of drug benefits, and the emphasis on parental and nutritional support in the guidelines, there is still widespread overuse of medical management in FGIDs such as regurgitation and infantile colic 26, 27, 29.…”

Section: Pharmacological Management Of Fgids In Early Lifementioning

confidence: 99%

“…For example, 5.2% of children born in 2012 received a proton pump inhibitor before their first birthday and the majority of infants who received these drugs were not diagnosed with severe gastro‐oesophageal reflux disease 29.…”

Section: Pharmacological Management Of Fgids In Early Lifementioning

confidence: 99%

Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants

et al. 2018

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AimRegurgitation, infantile colic and functional constipation are common functional gastrointestinal disorders (FGIDs) during infancy. Our aim was to carry out a concise review of the literature, evaluate the impact of these common FGIDs on infants and their families, and provide an overview of national and international guidelines and peer‐reviewed expert recommendations on their management.MethodsNational and international guidelines and peer‐reviewed expert recommendations on the management of regurgitation, infantile colic and functional constipation were examined and summarised.ResultsRegurgitation, infantile colic and functional constipation cause frequent parental concerns, lead to heavy personal and economic costs for families and impose a financial burden on public healthcare systems. Guidelines emphasise that the first‐line management of these common FGIDs should focus on parental education, reassurance and nutritional advice. Nutritional advice should stress the benefits of continuing breastfeeding, while special infant formulas may be considered for non‐breastfed infants with common FGIDs. Drug treatment is seldom required, with the exception of functional constipation.ConclusionBy providing complete and updated parental education, reassurance and nutritional advice, healthcare professionals can optimise the management of FGIDs and related symptoms and reduce the inappropriate use of medication or dietary interventions.

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National Study of Off‐label Proton Pump Inhibitor Use Among New Zealand Infants in the First Year of Life (2005–2012)

Abstract: Off-label prescribing of PPIs to New Zealand infants was relatively common and increased over the study period. The appropriateness of PPI treatment should be questioned, as the majority of infants who received these drugs were not diagnosed with severe GERD.

Cited by 44 publications

References 8 publications

Acid suppressants for managing gastro-oesophageal reflux and gastro-oesophageal reflux disease in infants: a national survey

Acid suppressants for managing gastro-oesophageal reflux and gastro-oesophageal reflux disease in infants: a national survey

Comparison of common interventions for the treatment of infantile colic: a systematic review of reviews and guidelines

Review shows that parental reassurance and nutritional advice help to optimise the management of functional gastrointestinal disorders in infants

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