scholarly journals Anti-reflux medication use in preterm infants

2021 ◽  
Author(s):  
Haslina Binti Abdul Hamid ◽  
Lisa Szatkowski ◽  
Helen Budge ◽  
Shalini Ojha
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Reflux Disease ◽  
Oesophageal Reflux ◽  
List Type ◽  
Research Database ◽  
Pharmacological Management ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Oesophageal Reflux Disease

Abstract Background Current recommendations do not support the use of anti-reflux medications to treat gastro-oesophageal reflux disease (GORD) among preterm infants. Objective To describe the prevalence of GORD and the use of anti-reflux medications amongst very preterm infants (<32 weeks’ gestational age (GA)) in neonatal units in England and Wales. Design Retrospective cohort study using the National Neonatal Research Database. Results Among 58,108 infants [median GA (IQR) 29 (27–30) weeks], 15.8% (n = 9191) had a diagnosis of GORD and 36.9% (n = 12,446) received anti-reflux medications. Those who received anti-reflux medications were more preterm [GA, median (IQR): medications, 28 (26–30) vs. no medications, 30 (28–31); p < 0.001] and had lower birth weight [mean (SD): medications, 1124 g (354) vs. no medications, 1265 g (384); p < 0.001]. Most (57%, n = 12,224) received Gaviscon, or Histamine-2 Receptor Antagonist (H2RA) (56%, n = 11,959). Over time, prokinetic use has declined substantially, the use of H2RAs and Gaviscon has reduced although they continue to be used frequently, whilst the use of PPIs has increased. Conclusions Anti-reflux medications are frequently prescribed in very preterm infants, despite evidence to suggest that they are not effective and may be harmful. Clear guidelines for diagnosing GORD and the use of anti-reflux medications are required to rationalise the pharmacological management of GORD in preterm infants. Impact Anti-reflux medications are frequently prescribed, often without a diagnosis of gastro-oesophageal reflux disease, to very preterm infants while in the neonatal unit and at discharge. Half of the infants born at <28 weeks’ gestational age receive anti-reflux medications in hospital and a quarter are discharged home on them. Although the use of prokinetics declined following alerts of adverse events, histamine2-receptor antagonists and alginates such as Gaviscon continue to be used and the use of proton-pump inhibitors has increased more than 2-fold.

Behaviour at 2 years of age in very preterm infants (gestational age <32 weeks)

2003 ◽  
Vol 92 (5) ◽  
pp. 1-1 ◽  
Author(s):  
GMSJ Stoelhorst ◽  
SE Martens ◽  
M Rijken ◽  
van Zwieten PHT ◽  
AH Zwinderman ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Very Preterm Infants ◽  
Very Preterm

Significance of low birthweight for gestational age among very preterm infants

1997 ◽  
Vol 104 (6) ◽  
pp. 668-673 ◽  
Author(s):  
Arsenio Spinillo ◽  
Ezio Capuzzo ◽  
Gaia Piazzi ◽  
Federica Baltaro ◽  
Mauro Stronati ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Low Birthweight ◽  
Very Preterm Infants ◽  
Very Preterm

67 Are NICUs too busy?

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e47-e48
Author(s):  
Marc Beltempo ◽  
Robert Platt ◽  
Anne-Sophie Julien ◽  
Regis Blais ◽  
Bertelle Valerie ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Patient Outcomes ◽  
Gestational Age ◽  
Late Onset ◽  
Mode Of Delivery ◽  
Random Effect ◽  
Organizational Factors ◽  
Neurological Injury ◽  
Very Preterm Infants ◽  
Very Preterm

Abstract Primary Subject area Neonatal-Perinatal Medicine Background In a health care system with limited resources, hospital organizational factors such as unit occupancy and nurse-to-patient ratios may contribute to patient outcomes. Objectives We aimed to assess the association of NICU occupancy and nurse staffing with outcomes of very preterm infants born &lt; 33 weeks gestational age (GA). Design/Methods This was a multicenter retrospective cohort study of infants born 23-32 weeks GA without major congenital anomaly, admitted within 2 days after birth to one of four Level 3 NICUs in Quebec, Canada (2015-2018). For each 8 h shift, data on unit occupancy were obtained from a central provincial database (SiteNeo) and linked to the hospital nursing hours database (Logibec). Unit occupancy rates and nursing provision ratios (nursing hours/recommended nursing hours based on patient dependency categories) were pooled for the first shift, 24 h, and 7 days of admission for each infant. Patient data were obtained from the Canadian Neonatal Network database. Primary outcome was mortality and/or morbidity (severe neurological injury, bronchopulmonary dysplasia, necrotizing enterocolitis, and late-onset sepsis, severe retinopathy of prematurity). Adjusted odds ratios (AOR) for association of exposure with outcomes were estimated using generalized linear mixed models with a random effect for center, while adjusting for confounders (gestational age, small for gestational age, sex, outborn, Score for Neonatal Acute Physiology version 2, mode of delivery, and the other organizational variables). Results Among 1870 infants included in analyses, 796 (43%) had mortality/morbidity. Median occupancy was 89% (IQR 82-94) and median nursing provision was 1.13 (IQR 0.97-1.37). Overall higher NICU occupancy on shift of admission, first 24 h, and 7 days were associated with higher odds of mortality/morbidity (Figure 1) but nursing provision was not (Figure 2). Subgroup analysis by GA (&lt; 29 and 29-32 weeks) yielded similar results (not shown). Generalized linear mixed model analyses showed that a 5% reduction in occupancy in the first 24 h of admission was associated with a 6% reduction in mortality/morbidity. Conclusion NICU occupancy is associated with mortality/morbidity among very preterm infants and may reflect lack of adequate resources in periods of high activity. Interventions aimed at reducing occupancy and maintaining adequate resources need to be considered as strategies to improve patient outcomes.

scholarly journals Pulse Oximetry Values in Very Preterm infants Asymtomatic at 34-36 weeks post menstrual age.

2020 ◽  
Author(s):  
Ignacio Oyarzún ◽  
Marcela Diaz ◽  
Paulina Toso ◽  
Alejandra Zamorano ◽  
Soledad Montes ◽  
...  
Keyword(s):  
Pulse Oximetry ◽  
Preterm Infants ◽  
Premature Infants ◽  
Gestational Age ◽  
Oxygen Therapy ◽  
Healthy Children ◽  
Multicentric Study ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Postmenstrual Age

Background: Oxygen supplementation is an important component for preterm infants neonatal care. Pulse oximetry (SpO2) is essential to guide oxygen therapy. Evidence on SpO2 values in premature infants previous to discharge is limited. Objectives: To establish SpO2 values in asymptomatic premature infants at 34, 35, and 36 weeks postmenstrual age (PMA). Methods: Longitudinal, multicentric study. From May 2018 to May 2019 premature infants born ≤32 weeks gestational age, from three level III NICUs in Santiago, Chile (altitude 579mt), were enrolled. Healthy children without current apnea of prematurity were included. Continuous SpO2 was obtained with Masimo-Radical 7/8 (USA), averaging time 2-4 seconds. Results: 101 SpO2 recordings (n = 44, 33 and 24 at 34, 35 and 36 weeks PMA respectively) from 62 infants. Twenty eight (45%) male, median (range) gestational age at birth 30 (26-32) weeks, median (range) birth weight 1480 (785-2700) g. Oximetry variables for total recordings: mean SpO2, median (range) 96.9 (93.3-99.3); minimum SpO2, median (range) 74 (51-89); time of SpO2 <90%, median (range) 2% (0-10.6%); time of SpO2 <80%, median (range) 0.1% (0-1.3%); desaturation event by ≥4% (DI4) ≥ 0 and ≥ 10 seconds per sample hour, median (range) 45.2 (5.2-115) and median (range) 15 (3.5-62.5) respectively; desaturation event <80% (DI80), median (range) 0.58 (0-10.8). We found no differences between SpO2 values at different weeks PMA. Conclusions: We described SpO2 values in very preterm infants, asymptomatic at 34, 35 and 36 weeks PMA. These values could be used as a reference to guide oxygen therapy previous to discharge.

Neurodevelopmental Follow-up of Very Preterm Infants after Proactive Treatment at a Gestational Age of ≥23 Weeks

2008 ◽  
Vol 152 (6) ◽  
pp. 771-776.e2 ◽  
Author(s):  
Jochen Steinmacher ◽  
Frank Pohlandt ◽  
Harald Bode ◽  
Silvia Sander ◽  
Martina Kron ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Very Preterm Infants ◽  
Very Preterm

Pharmacological Management of Gastro-Oesophageal Reflux Disease

Drugs ◽  
1995 ◽  
Vol 49 (5) ◽  
pp. 695-710 ◽  
Author(s):  
Elly C. Klinkenberg-Knol ◽  
Henk P.M. Festen ◽  
Stephan G.M. Meuwissen
Keyword(s):  
Reflux Disease ◽  
Oesophageal Reflux ◽  
Pharmacological Management ◽  
Oesophageal Reflux Disease

scholarly journals Adverse effects of small for gestational age differ by gestational week among very preterm infants

2018 ◽  
Vol 104 (2) ◽  
pp. F192-F198 ◽  
Author(s):  
Erik A Jensen ◽  
Elizabeth E Foglia ◽  
Kevin C Dysart ◽  
Rebecca A Simmons ◽  
Zubair H Aghai ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Intraventricular Haemorrhage ◽  
Neonatal Morbidity ◽  
Excess Risk ◽  
Very Preterm Infants ◽  
Adjusted Risk ◽  
Very Preterm ◽  
Grade 3

ObjectiveTo characterise the excess risk for death, grade 3–4 intraventricular haemorrhage (IVH), bronchopulmonary dysplasia (BPD) and stage 3–5 retinopathy of prematurity independently associated with birth small for gestational age (SGA) among very preterm infants, stratified by completed weeks of gestation.MethodsRetrospective cohort study using the Optum Neonatal Database. Study infants were born <32 weeks gestation without severe congenital anomalies. SGA was defined as a birth weight <10th percentile. The excess outcome risk independently associated with SGA birth among SGA babies was assessed using adjusted risk differences (aRDs).ResultsOf 6708 infants sampled from 717 US hospitals, 743 (11.1%) were SGA. SGA compared with non-SGA infants experienced higher unadjusted rates of each study outcome except grade 3–4 IVH among survivors. The excess risk independently associated with SGA birth varied by outcome and gestational age. The highest aRD for death (0.27; 95% CI 0.13 to 0.40) occurred among infants born at 24 weeks gestation and declined as gestational age increased. In contrast, the peak aRDs for BPD among survivors (0.32; 95% CI 0.20 to 0.44) and the composites of death or BPD (0.35; 95% CI 0.24 to 0.46) and death or major morbidity (0.35; 95% CI 0.24 to 0.45) occurred at 27 weeks gestation. The risk-adjusted probability of dying or developing one or more of the evaluated morbidities among SGA infants was similar to that of non-SGA infants born approximately 2–3 weeks less mature.ConclusionThe excess risk for neonatal morbidity and mortality associated with being born SGA varies by adverse outcome and gestational age.

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