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Pharmacological therapy of gastroesophageal reflux in preterm infants
Luigi Corvaglia1, Caterina Monari, Silvia Martini
1Neonatology and Neonatal Intensive Care Unit, S. Orsola-Malpighi Hospital, via Massarenti 11, 40138 Bologna, Italy ; Department of Medical and Surgical Sciences (DIMEC), University of Bologna, 40126 Bologna, Italy.
Insights
Gastroesophageal reflux (GER) in preterm infants is common, but drug use is debated. Non-drug approaches are preferred, as many GER medications lack safety data and carry risks like infections and necrotizing enterocolitis.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Pharmacology
Background:
- Gastroesophageal reflux (GER) is highly prevalent in preterm infants, yet its optimal management remains controversial.
- A trend towards pharmacological overtreatment of GER in this population has been observed, despite limited evidence and potential risks.
- Many anti-reflux medications lack specific assessment in preterm infants and have associated adverse effects.
Purpose of the Study:
- To review the current evidence on the pharmacological management of GER in preterm infants.
- To analyze the efficacy and safety of commonly prescribed anti-reflux drugs for preterm infants.
- To provide an overview of the state-of-the-art regarding drug therapy for GER in this vulnerable population.
Main Methods:
- Systematic review of existing literature on GER management in preterm infants.
- Analysis of clinical trial data and observational studies on anti-reflux medications.
- Evaluation of safety profiles and risk-benefit ratios of different drug classes.
Main Results:
- Sodium alginate formulations show potential but require further safety data.
- Histamine-2 receptor blockers and proton pump inhibitors have limited efficacy data and are linked to increased risks of infections and necrotizing enterocolitis.
- Metoclopramide's efficacy is unclear; domperidone and erythromycin appear ineffective, and cisapride was withdrawn due to cardiac risks.
Conclusions:
- Non-pharmacological interventions should be prioritized for GER in preterm infants.
- The use of histamine-2 receptor blockers and proton pump inhibitors in preterm infants with GER is associated with an unfavorable risk-benefit ratio.
- Further research is needed to establish safe and effective pharmacological treatments for GER in preterm infants, with sodium alginate showing some promise.
Abstract:
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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