Pharmacological interventions for prevention and treatment of upper gastrointestinal bleeding in newborn infants

Green, Daniel S; Abdellatif, Mohamed; Jones, Lisa J; Osborn, David A

doi:10.1002/14651858.cd011785

Cited by 4 publications

(2 citation statements)

References 22 publications

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“…In hour study we did not observed hepatic impairment from octreotide consumption or signi cant rise in hepatic aminotransferases. In critically ill patients GI bleeding is more frequent than non-critically ill patient [19] but acute GI bleeding with clinical symptoms (hemodynamic instability, decrease in hemoglobin for 2 g/dL or more and blood transfusion) is less frequent. In developing countries GI bleeding occurred as a result of GI varices, mostly.…”

Section: Discussionmentioning

confidence: 99%

Octreotide Safety and Efficacy in Pediatric Non-variceal Upper Gastrointestinal Bleeding, A Randomized Controlled Trial

Mirrahimi

Rohani

Moradi

et al. 2020

Preprint

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Background: Octreotide as somatostatin analogue decrease the production of gastrointestinal (GI) peptides. Its consumption in pediatric population has been limited to control of bleeding episodes with variceal origin. In this randomized controlled trial, we aim to assess octreotide as an add-on therapy to conventional regimen of proton pump inhibitors in controlling upper GI bleeding in pediatric population.Methods: In a prospective randomized controlled clinical trial, in Mofid Children's Hospital, Tehran, Iran, pediatric patients with age of 0 to 15 years diagnosed with acute non-variceal upper GI bleeding allocated to receive Octreotide or placebo and pantoprazole concomitantly. Medication administration initiated after patient’s stabilization. Patients with hepatic failure, liver stigma, coagulopathy thrombocytopenia etc. were excluded. Demographic, clinical and preclinical data were recorded in prepared sheets. All patients were followed until therapy discontinuation.Results: Forty-three patients with the mean age of 4.98 ± 3.79 years with confirmed non-variceal upper GI bleeding included to the study. Most patients had no specific etiology for their bleeding episode. Patients in intervention and control group received pantoprazole in comparable doses. No differences in baseline hemoglobin values was observed but final hemoglobin values were higher in intervention group. No differences in bleeding duration observed. In regard of adverse drug reaction due to octreotide infusion, none was observed in any patient. Conclusions: Our study demonstrated that octreotide does not alter bleeding duration but need for transfusion in non-variceal upper GI bleeding but it may have effect on amount of blood loss.Trial registration: The study was registered in Iranian Registry of Clinical Trial by the code of IRCT20120415009475N6.

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Section: Discussionmentioning

confidence: 99%

Octreotide Safety and Efficacy in Pediatric Non-variceal Upper Gastrointestinal Bleeding, A Randomized Controlled Trial

Mirrahimi

Rohani

Moradi

et al. 2020

Preprint

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“…Another systematic review by Green et al, based on 11 studies involving > 800 preterm and term neonates confirmed the efficacy of H2-blockers in preventing gastrointestinal bleeding. Given that no single study reported the incidence of NEC, the authors concluded that the safety of H2-blockers in this regard remained unclear (33).…”

Section: Discussionmentioning

confidence: 99%

The Effects of Ranitidine Treatment on the Risk of Necrotizing Enterocolitis in Preterm Infants: A Case-Control Study

Zvizdić

Milišić

Jonuzi

et al. 2021

Acta Med. (Hradec Kralove, Czech Repub.)

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Introduction: Gastric acidity plays an important role in the protection of infants against various pathogens from the environment. The histamine-2 receptor blockers (H2-blockers) are off-labeled drugs that are frequently prescribed in preterm neonates to prevent stress ulcers. The impact of the H2-blockers on the development of the necrotizing enterocolitis (NEC) in preterm infants is still controversial, particularly in the developing world. Materials and Methods: One hundred twenty-two preterm infants were enrolled in the study. The multivariate logistic regression model was used to identify potential postnatal risk factors associated with NEC. Results: Preterm infants (n = 51) with total NEC, medical NEC, and surgical NEC had the highest rate of receiving ranitidine compared with controls (n = 71) (39.2%, 19.6%, and 47.6%, p < 0.05). Logistic regression analysis revealed that ranitidine use and nosocomial infections were significantly associated with NEC development (odds ratios 1.55 and 3.3). Conclusions: We confirm that ranitidine administration was associated with an increased risk of NEC in preterm infants. H2-blockers use should be only administered in very strictly selected cases after careful consideration of the risk-benefit ratio.

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Analysis of Neurodevelopment in Children Born Extremely Preterm Treated With Acid Suppressants Before Age 2 Years

Jensen

Jackson

et al. 2022

JAMA Netw Open

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ImportanceChildren born preterm are at increased risk of adverse neurodevelopmental outcomes and may be particularly vulnerable to the effects of gastric acid suppression during infancy.ObjectiveTo assess whether early acid suppressant use in infants born extremely preterm is associated with poorer neurodevelopmental outcomes.Design, Setting, and ParticipantsThe Extremely Low Gestational Age Newborn study was a multicenter, longitudinal cohort study of infants born before 28 weeks’ gestational age between March 22, 2002, and August 31, 2004. The current analyses were performed from September 12, 2020, through September 22, 2022. Of the 1506 infants enrolled, 284 died before discharge and 22 died before 24 months of age. An additional 2 died before age 10 years, leaving 1198 (79.5%) eligible for a visit. Of these, 889 (74%) participated in the visit at age 10. At age 10 years, the association of early-life acid suppressant use with neurocognitive, neurodevelopmental, and psychiatric symptomatology was assessed.ExposuresAcid suppressant use before 24 months of age was determined from medical records and from questionnaires administered to mothers.Main Outcomes and MeasuresNeurodevelopmental assessments at age 10 years included the School-Age Differential Ability Scales–II, the Developmental Neuropsychological Assessment-II, the Autism Diagnostic Observation Schedule-2, the Social Responsiveness Scale-2, and the Child Symptom Inventory-4 for attention-deficit/hyperactivity disorder (ADHD), depression, and anxiety.ResultsOf the 889 participants assessed at age 10 years (mean [SD] age, 9.97 [0.67] years; mean [SD] gestational age at birth, 26.1 [1.3] weeks; 455 [51.2%] male), 368 (41.4%) had received acid suppressants by 24 months of age. Associations were observed between acid suppressant use and decreased full-scale IQ z score (adjusted β, −0.29; 95% CI, −0.45 to −0.12), verbal IQ z score (adjusted β, −0.34; 95% CI, −0.52 to −0.15), nonverbal IQ z score (adjusted β, −0.22; 95% CI to −0.39 to −0.05), working memory z score (adjusted β, −0.26; 95% CI to −0.45, −0.08), autism spectrum disorder (adjusted relative risk, 1.84; 95% CI, 1.15-2.95), and epilepsy (adjusted relative risk, 2.07; 95% CI, 1.31 to 3.35). Results were robust to multiple sensitivity analyses. Use of acid suppressants was not associated with inhibitory control, ADHD, anxiety, or depression.Conclusions and RelevanceThe results of this cohort study suggest that early-life use of acid suppressants in extremely preterm infants may be associated with poorer neurodevelopmental outcomes and add to evidence indicating caution in use of these agents.

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Pharmacological interventions for prevention and treatment of upper gastrointestinal bleeding in newborn infants

Cited by 4 publications

References 22 publications

Octreotide Safety and Efficacy in Pediatric Non-variceal Upper Gastrointestinal Bleeding, A Randomized Controlled Trial

Octreotide Safety and Efficacy in Pediatric Non-variceal Upper Gastrointestinal Bleeding, A Randomized Controlled Trial

The Effects of Ranitidine Treatment on the Risk of Necrotizing Enterocolitis in Preterm Infants: A Case-Control Study

Analysis of Neurodevelopment in Children Born Extremely Preterm Treated With Acid Suppressants Before Age 2 Years

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