Pharmacological Therapy of Gastroesophageal Reflux in Preterm Infants

Although gastroesophageal reflux (GER) is a very common phenomenon among preterm infants, its therapeutic management is still an issue of debate among neonatologists. A step-wise approach should be advisable, firstly promoting nonpharmacological interventions and limiting drugs to selected infants unresponsive to the conservative measures or who are suffering from severe GER with clinical complications. Despite of this, a concerning pharmacological overtreatment has been increasingly reported. Most of the antireflux drugs, however, have not been specifically assessed in preterm infants; moreover, serious adverse effects have been noticed in association to their administration. This review mainly aims to draw the state of the art regarding the pharmacological management of GER in preterm infants, analyzing the best piecies of evidence currently available on the most prescribed anti-reflux drugs. Although further trials are required, sodium alginate-based formulations might be considered promising; however, data regarding their safety are still limited. Few piecies of evidence on the efficacy of histamine-2 receptor blockers and proton pump inhibitors in preterm infants with GER are currently available. Nevertheless, a significantly increased risk of necrotizing enterocolitis and infections has been largely reported in association with their use, thereby leading to an unfavorable risk-benefit ratio. The efficacy of metoclopramide in GER’s improvement still needs to be clarified. Other prokinetic agents, such as domperidone and erythromycin, have been reported to be ineffective, whereas cisapride has been withdrawn due to its remarkable cardiac adverse effects.

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Transpiloric feeding in gastroesophageal reflux in neonatology

Pediatrician (St Petersburg) ◽

10.17816/ped12459-67 ◽

2021 ◽

Vol 12 (4) ◽

pp. 59-67

Author(s):

O. G. Smirnov ◽

V. I. Gorbachev ◽

N. G. Aleinikova

Keyword(s):

Gastroesophageal Reflux ◽

Enteral Nutrition ◽

Preterm Infants ◽

Feeding Tube ◽

Critically Ill Children ◽

First Line Therapy ◽

Clinical Complications ◽

Premature Babies ◽

Iatrogenic Complications ◽

Seriously Ill

Optimizing nutritional support is essential for critically ill children, and premature infants are particularly vulnerable to the effects of prolonged fasting. There is a lot of evidence in the scientific literature for the benefits of enteral nutrition. It is known that premature babies need an individual approach to nutrition due to the prevalence of catabolic processes, while treatment in the intensive care unit requires a surplus of calories. Timely introduction of enteral nutrition helps to reduce morbidity and mortality in this population. Gastroesophageal reflux is common in preterm infants. When there is a decrease in tolerance to enteral feeding, doctors usually prefer parenteral nutrition. However, its use can be associated with metabolic, infectious and iatrogenic complications. A step-by-step therapeutic approach is recommended in the treatment of GER in preterm infants. Conservative treatment should be considered as first-line therapy in children without clinical complications. Feeding through a gastric tube is not always well tolerated by seriously ill people patients. As for the treatment of complicated GER, extensive studies show that the use of transpiloric feeding is comparable in effectiveness to fundoplication. Transpiloric feeding tube can be justified as a strategy for treating GER that is refractory to conservative therapy.

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Selenium deficiency and the effects of supplementation on preterm infants

Revista Paulista de Pediatria ◽

10.1590/s0103-05822014000100019 ◽

2014 ◽

Vol 32 (1) ◽

pp. 126-135 ◽

Cited By ~ 15

Author(s):

Renata Germano B. O. N. Freitas ◽

Roberto Jose N. Nogueira ◽

Maria Angela R. G. M. Antonio ◽

Antonio de Azevedo Barros-Filho ◽

Gabriel Hessel

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Clinical Status ◽

Selenium Deficiency ◽

Optimal Dose ◽

Selenium Supplementation ◽

Blood Concentrations ◽

Clinical Complications ◽

Increased Risk

Objective: This study aimed to review the literature about blood concentrations of selenium associated with gestational age, feeding, supplementation and related clinical features in preterm infants. Data sources: Systematic review in the following databases: MEDLINE, PubMed, Google academics, SciELO. org, ScienceDirect (Elsevier) and CINAHL-Plus with Full Text (EBSCO). Articles published up to January 2013 with the keywords "selenium deficiency", "selenium supplementation", "neonates", "infants", "newborn" and "preterm infants" were selected. Data synthesis: The studies reported that low blood selenium levels are associated with increased risk of respiratory diseases. Preterm infants, especially with low birth weight, presented lower selenium levels. Selenium deficiency has also been associated with the use of oral infant formula, enteral and parenteral nutrition (with or without selenium addition). The optimal dose and length of selenium supplementation is not well-established, since they are based only on age group and selenium ingestion by breastfed children. Furthermore, the clinical status of the infant affected by conditions that may increase oxidative stress, and consequently, selenium requirements is not taken into account. Conclusions: Prematurity and low birth weight can contribute to low blood selenium in premature infants. Selenium supplementation seems to minimize or prevent clinical complications caused by prematurity.

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Nonpharmacological Management of Gastroesophageal Reflux in Preterm Infants

BioMed Research International ◽

10.1155/2013/141967 ◽

2013 ◽

Vol 2013 ◽

pp. 1-7 ◽

Cited By ~ 17

Author(s):

Luigi Corvaglia ◽

Silvia Martini ◽

Arianna Aceti ◽

Santo Arcuri ◽

Roberto Rossini ◽

...

Keyword(s):

Gastroesophageal Reflux ◽

Adverse Effects ◽

Preterm Infants ◽

Conservative Management ◽

Pathological Condition ◽

Controversial Issue ◽

Physiological Mechanisms ◽

Stepwise Approach ◽

Potential Benefits ◽

Body Positioning

Gastroesophageal reflux (GOR) is very common among preterm infants, due to several physiological mechanisms. Although GOR should not be usually considered a pathological condition, its therapeutic management still represents a controversial issue among neonatologists; pharmacological overtreatment, often unuseful and potentially harmful, is increasingly widespread. Hence, a stepwise approach, firstly promoting conservative strategies such as body positioning, milk thickening, or changes of feeding modalities, should be considered the most advisable choice in preterm infants with GOR. This review focuses on the conservative management of GOR in the preterm population, aiming to provide a complete overview, based on currently available evidence, on potential benefits and adverse effects of nonpharmacological measures. Nonpharmacological management of GOR might represent a useful tool for neonatologists to reduce the use of antireflux medications, which should be limited to selected cases of symptomatic babies.

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Platelet monitoring for PCI

Hämostaseologie ◽

10.1055/s-0037-1617137 ◽

2009 ◽

Vol 29 (04) ◽

pp. 376-380 ◽

Cited By ~ 9

Author(s):

D. Capodanno ◽

D. J. Angiolillo

Keyword(s):

Interindividual Variability ◽

State Of The Art ◽

Coronary Intervention ◽

Functional Tests ◽

Treatment Regimens ◽

Advantages And Disadvantages ◽

Coronary Syndrome ◽

Combined Use ◽

Increased Risk ◽

Percutaneous Coronary

SummaryDespite the clinical benefit associated with the combined use of aspirin and clopidogrel in patients with acute coronary syndrome or those undergoing percutaneous coronary intervention, a considerable interindividual variability in response to these drugs have been consistently reported. There is a growing interest on applying platelet functional tests with the goal of identifying patients at increased risk of recurrent ischaemic events and potentially tailoring antiplatelet treatment regimens.This manuscript will review the state of the art on the most commonly available platelet functional tests, describing their advantages and disadvantages and exploring their applicability in clinical practice.

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State-of-the-art, approved therapeutics for the pharmacological management of osteosarcoma

Expert Opinion on Pharmacotherapy ◽

10.1080/14656566.2021.1936499 ◽

2021 ◽

Author(s):

Cristina Meazza ◽

Sebastian Dorin Asaftei

Keyword(s):

State Of The Art ◽

Pharmacological Management

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Comparative effects of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on pulmonary function in hypertensive patients

Journal of Basic and Clinical Physiology and Pharmacology ◽

10.1515/jbcpp-2020-0243 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Azza S. Jabbar ◽

Nadheera F. Neamah ◽

Ahmed H. Al-Darraji

Keyword(s):

Angiotensin Ii ◽

Adverse Effects ◽

Angiotensin Converting Enzyme ◽

Enzyme Inhibitors ◽

Angiotensin Converting Enzyme Inhibitors ◽

Converting Enzyme ◽

Angiotensin Ii Receptor ◽

Converting Enzyme Inhibitors ◽

Hypertensive Patients ◽

Receptor Blockers

Abstract Objectives Hypertension is a very common cardiovascular disease. Angiotensin-converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARBs) are widely used to treat hypertension. Many patients with hypertension are vulnerable to the antihypertensive adverse effects, which potentially reduces the adherence rate. Therefore, we conducted this study in order to evaluate the safety profile of both classes (ACEi and ARBs) on respiratory functions. Methods Two main groups of subjects were studied: first group is healthy control subjects and the second group is hypertensive patients, which was subdivided into subgroups in order to investigate the effect of all tested medications (captopril, enalapril, lisinopril, losartan, and valsartan). Respiratory efficiency was evaluated by measuring pulmonary function tests: FEV1, FVC, and FEV1%. Measurements were done using micromedical spirometer. Results We found that ARBs do not impair normal respiratory functions as measured by FEV1, FEV1%, and FVC in hypertensive patients. While ACEi treatments significantly reduced FEV1, FEV1%, and FVC compared to the other groups. Conclusions ARBs are not associated with any harmful effects on respiratory functions in hypertensive patients, unlike ACEi. As such, they could represent a first-choice treatment for hypertensive patients who are at high risk to the respiratory adverse effects.

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The Risk of Necrotizing Enterocolitis following the Administration of Hyperosmolar Enteral Medications to Extremely Preterm Infants

Neonatology ◽

10.1159/000513169 ◽

2021 ◽

pp. 1-7

Author(s):

Faiza Latheef ◽

Hanna Wahlgren ◽

Helene Engstrand Lilja ◽

Barbro Diderholm ◽

Mattias Paulsson

Keyword(s):

Clinical Practice ◽

Preterm Infants ◽

Necrotizing Enterocolitis ◽

Neonatal Intensive Care ◽

Significant Risk ◽

Quality Register ◽

Increased Risk ◽

Extremely Preterm ◽

Extremely Preterm Infants ◽

Hyperosmolar Solutions

Introduction: Necrotizing enterocolitis (NEC) is a disease predominantly affecting preterm infants. The administration of hyperosmolar solutions could lead to the development of NEC. The objective of this study was to measure the osmolality of enteral medications used in clinical practice and to assess the risk of NEC following exposure to hyperosmolar medications. Methods: A retrospective cohort study in extremely preterm infants (gestational age <28 weeks) born between 2010 and 2016 at a tertiary neonatal intensive care unit in Sweden. 465 infants were identified via the Swedish Neonatal Quality register. Data relating to enteral administrations received during a two-week period were collected from the medical records. The osmolalities of medications were measured using an osmometer. Logistic regression was used to calculate the odds ratio of developing NEC. Results: A total of 253 patients met the inclusion criteria. The osmolalities of 5 commonly used medications significantly exceeded the recommended limit of 450 mOsm/kg set by the American Academy of Paediatrics (AAP). Most patients (94%) received at least one hyperosmolar medication. No significant risk of developing NEC could be found. Conclusion: The medications used in clinical practice can significantly exceed the limit set by the AAP. This study does not indicate an increased risk of developing NEC in extremely preterm infants following exposure to hyperosmolar medications. Further studies in larger cohorts are needed to determine the specific cut-off level of osmolality in relation to the pathogenesis of NEC.

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Surgical treatment of recalcitrant gastroesophageal reflux disease in patients with systemic sclerosis: a systematic review

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02118-8 ◽

2021 ◽

Author(s):

Alberto Aiolfi ◽

Mario Nosotti ◽

Kazuhide Matsushima ◽

Carolina Perali ◽

Cristina Ogliari ◽

...

Keyword(s):

Systematic Review ◽

Systemic Sclerosis ◽

Surgical Treatment ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Reflux Disease ◽

Current Data ◽

Current Evidence ◽

Increased Risk

Abstract Introduction Gastroesophageal reflux disease (GERD) is frequently seen in patients with systemic sclerosis (SSc). Long-standing GERD may cause esophagitis, long-segment strictures, and Barrett’s esophagus and may worsen pre-existing pulmonary fibrosis with an increased risk of end-stage lung disease. Surgical treatment of recalcitrant GERD remains controversial. The purpose of this systematic review was to summarize the current data on surgical treatment of recalcitrant GERD in SSc patients. Materials and methods A systematic literature review according to PRISMA and MOOSE guidelines. PubMed, EMBASE, and Web of Science databases were consulted. Results A total of 101 patients were included from 7 studies. The age ranged from 34 to 61 years and the majority were females (73.5%). Commonly reported symptoms were heartburn (92%), regurgitation (77%), and dysphagia (74%). Concurrent pulmonary disease was diagnosed in 58% of patients. Overall, 63 patients (62.4%) underwent open fundoplication, 17 (16.8%) laparoscopic fundoplication, 15 (14.9%) Roux en-Y gastric bypass (RYGB), and 6 (5.9%) esophagectomy. The postoperative follow-up ranged from 12 to 65 months. Recurrent symptoms were described in up to 70% and 30% of patients undergoing fundoplication and RYGB, respectively. Various symptoms were reported postoperatively depending on the type of surgical procedures, anatomy of the valve, need for esophageal lengthening, and follow-up. Conclusions The treatment of recalcitrant GERD in SSc patients is challenging. Esophagectomy should be reserved to selected patients. Minimally invasive RYGB appears feasible and safe with promising preliminary short-term results. Current evidence is scarce while a definitive indication about the most appropriate surgical treatment is lacking.

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Are Probiotics and Prebiotics Safe for Use during Pregnancy and Lactation? A Systematic Review and Meta-Analysis

Nutrients ◽

10.3390/nu13072382 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2382

Author(s):

Hauna Sheyholislami ◽

Kristin L. Connor

Keyword(s):

Systematic Review ◽

Adverse Effects ◽

English Language ◽

Clinical Decision Making ◽

Lactobacillus Rhamnosus ◽

Potential Health ◽

Increased Risk ◽

Pregnancy And Lactation ◽

Adverse Pregnancy ◽

Synbiotic Supplementation

Probiotic and prebiotic products have shown potential health benefits, including for the prevention of adverse pregnancy outcomes. The incidence of adverse effects in pregnant people and their infants associated with probiotic/prebiotic/synbiotic intake, however, remains unclear. The objectives of this study were to evaluate the evidence on adverse effects of maternal probiotic, prebiotic, and/or synbiotic supplementation during pregnancy and lactation and interpret the findings to help inform clinical decision-making and care of this population. A systematic review was conducted following PRISMA guidelines. Scientific databases were searched using pre-determined terms, and risk of bias assessments were conducted to determine study quality. Inclusion criteria were English language studies, human studies, access to full-text, and probiotic/prebiotic/synbiotic supplementation to the mother and not the infant. In total, 11/100 eligible studies reported adverse effects and were eligible for inclusion in quantitative analysis, and data were visualised in a GOfER diagram. Probiotic and prebiotic products are safe for use during pregnancy and lactation. One study reported increased risk of vaginal discharge and changes in stool consistency (relative risk [95% CI]: 3.67 [1.04, 13.0]) when administering Lactobacillus rhamnosus and L. reuteri. Adverse effects associated with probiotic and prebiotic use do not pose any serious health concerns to mother or infant. Our findings and knowledge translation visualisations provide healthcare professionals and consumers with information to make evidence-informed decisions about the use of pre- and probiotics.

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Renin-angiotensin system blocker and outcomes of COVID-19: a systematic review and meta-analysis

Thorax ◽

10.1136/thoraxjnl-2020-215322 ◽

2021 ◽

pp. thoraxjnl-2020-215322

Author(s):

Hyun Woo Lee ◽

Chang-Hwan Yoon ◽

Eun Jin Jang ◽

Chang-Hoon Lee

Keyword(s):

Systematic Review ◽

Meta Analysis ◽

Severe Disease ◽

Renin Angiotensin System ◽

Angiotensin Ii Receptor ◽

Angiotensin System ◽

Risk Of Mortality ◽

Increased Risk ◽

All Cause Mortality ◽

Receptor Blockers

BackgroundThe association of ACE inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) with disease severity of patients with COVID-19 is still unclear. We conducted a systematic review and meta-analysis to investigate if ACEI/ARB use is associated with the risk of mortality and severe disease in patients with COVID-19.MethodsWe searched all available clinical studies that included patients with confirmed COVID-19 who could be classified into an ACEI/ARB group and a non-ACEI/ARB group up until 4 May 2020. A meta-analysis was performed, and primary outcomes were all-cause mortality and severe disease.ResultsACEI/ARB use did not increase the risk of all-cause mortality both in meta-analysis for 11 studies with 12 601 patients reporting ORs (OR=0.52 (95% CI=0.37 to 0.72), moderate certainty of evidence) and in 2 studies with 8577 patients presenting HRs. For 12 848 patients in 13 studies, ACEI/ARB use was not related to an increased risk of severe disease in COVID-19 (OR=0.68 (95% CI=0.44 to 1.07); I2=95%, low certainty of evidence).ConclusionsACEI/ARB therapy was not associated with increased risk of all-cause mortality or severe manifestations in patients with COVID-19. ACEI/ARB therapy can be continued without concern of drug-related worsening in patients with COVID-19.

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