Previous studies have shown that the use of acid suppressing medications in hospitalized high-risk babies has been linked to infection, necrotizing enterocolitis (a disease in which intestinal tissues are damaged and die), and increased risk of death. Despite the risks, 1 in 4 infants in the nation’s neonatal intensive care units (NICUs) are given heartburn drugs, according to a new study published online April 27 in The Journal of Pediatrics.
“The number is surprising, because there are now multiple studies that say these drugs are associated with harmful effects,” lead author Jonathan L. Slaughter, MD, MPH, a neonatologist at Nationwide Children’s Hospital in Columbus, Ohio, said in a hospital news release. “There’s actually little evidence that acid suppression helps in the NICU at all,” he added.
In fact, Slaughter, who is also a principal investigator in the Center for Perinatal Research at Children’s Nationwide, and an assistant professor of Pediatrics at The Ohio State University College of Medicine, noted that some amount of stomach acid likely protects these babies, who have compromised immune systems, from harmful bacteria.
The drugs in question include H2 blockers such as Zantac, and proton pump inhibitors (PPIs) such as Nexium and Prilosec. Though not approved for use in newborns, doctors prescribe the drugs to treat gastroesophageal reflux disease (GERD), a condition where food backs up (refluxes) from a baby’s stomach, causing the baby to spit up. Doctors are also likely to prescribe acid suppressants for infants with congenital heart disease and ear, nose and throat conditions.
For the study, Slaughter and his colleagues at Nationwide Children’s Hospital analyzed data from 43 children’s hospitals across the U.S. from 2006 to 2013. Their findings showed that nearly 24 percent of 122,000 newborns received either an H2 blocker or a PPI.
While the number of infants receiving the acid suppressants remains surprisingly high, there has been a decline in their use in recent years. The researchers found that the percentage of babies getting H2 blockers went down from 2006 to 2013, while the percentage of babies treated with PPIs rose until 2010, but then declined afterward.
Slaughter viewed the decline as a sign that doctors were starting to pay attention to the warnings. “In the small premature babies who are prescribed acid suppressive medications, doctors are waiting longer, until they are a little older,” he said.
“That’s promising,” Slaughter added. “But I think the number should be declining faster, and the research community should continue to devote resources to study the drugs’ effectiveness and safety.”
The study also found that babies treated with acid suppressants in the NICU were still taking them at the time of discharge. Slaughter said doctors should consider a plan to wean the babies off the medications before they leave the hospital. He pointed out that parents want to know that their children can eventually stop taking the drugs.
“Parents are right to ask questions and voice concerns about starting the drugs, or about the timetable for stopping,” Slaughter said. “Parents should not be afraid to ask about evidence that their children can eventually stop the medicine.”