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Morbidity and Mortality in Preterm Infants following Antacid Use: A Retrospective Audit
Natasha Singh1, Aparna Dhayade2, Abdel-Latif Mohamed2
1Australian National University Medical School, Canberra, ACT 2601, Australia.
Insights
Use of ranitidine and omeprazole in very low birth weight (VLBW) infants is not linked to higher risks of infection, necrotizing enterocolitis (NEC), or death. Adjusted analysis even showed a lower risk of late-onset sepsis in VLBW neonates receiving these medications.
Area of Science:
- Neonatal intensive care
- Pediatric pharmacology
- Infectious disease epidemiology
Background:
- Antacids are frequently prescribed to preterm infants, often for misdiagnosed gastro-oesophageal reflux.
- Suppression of gastric acidity by antacids can compromise a crucial defense mechanism against infection.
- This study investigates the safety of ranitidine and omeprazole in very low birth weight (VLBW) neonates.
Purpose of the Study:
- To determine if ranitidine and omeprazole use in VLBW neonates (<1500 grams) is associated with an increased risk of late-onset sepsis, necrotizing enterocolitis (NEC), and mortality.
- To evaluate the safety profile of acid-suppressing medications in a vulnerable preterm infant population.
Main Methods:
- Retrospective analysis of neonates (<1500 grams) admitted to the Neonatal Intensive Care Unit at The Canberra Hospital (2008-2012).
- Data collected included incidence of late-onset sepsis, NEC, mortality, ranitidine/omeprazole use, and relevant neonatal/hospital factors.
- Statistical analysis, including odds ratios and p-values, was performed to compare outcomes between medication users and non-users, with adjustments for confounding factors.
Main Results:
- Out of 360 neonates, 64 received ranitidine and/or omeprazole.
- No statistically significant differences in the incidence of late-onset sepsis, NEC (Stage 2+), or mortality were observed between the groups initially.
- After adjusting for confounding factors, ranitidine/omeprazole use was associated with a significantly lower risk of late-onset sepsis (OR = 0.28, p = 0.003).
Conclusions:
- Ranitidine and omeprazole use in VLBW preterm infants does not appear to increase the risk of infection, NEC, or mortality.
- The findings suggest a potential protective effect against late-onset sepsis in VLBW neonates treated with these medications.
- Further research may be warranted to confirm these safety and potential protective findings.
Abstract:
Background and Objectives. Antacids are often prescribed to preterm infants due to misdiagnosis of gastro-oesophageal reflux. This suppresses gastric acidity, a major defence mechanism against infection. This study aims to determine if ranitidine and omeprazole use in very low birth weight (VLBW) neonates, <1500 grams, is associated with increased risk of late onset sepsis, necrotising enterocolitis (NEC), and mortality. Methods. Retrospective analysis was conducted on neonates, <1500 grams, born and admitted into the Neonatal Intensive Care Unit at The Canberra Hospital during the period from January 2008 to December 2012. Information regarding late onset sepsis, NEC, mortality, ranitidine/omeprazole use, and other neonatal/hospital factors was collected for each neonate. Results. 360 neonates were evaluated, 64 received ranitidine and/or omeprazole, and 296 had not. There were no statistically significant differences in incidence of late onset sepsis (OR = 0.52, CI = 0.24-1.1, and p = 0.117), NEC Stage 2 and above (OR = 0.4, CI = 0.05-3.2, and p = 0.7), or mortality (OR = 0.35, CI = 0.08-1.5, and p = 0.19) between the two groups. After adjusting significant differences in neonatal and hospital factors, risk of late onset sepsis was significantly lower in those that received ranitidine/omeprazole (OR = 0.28, CI = 0.13-0.65, and p = 0.003). Conclusions. Ranitidine and omeprazole use in VLBW preterm infants may not be associated with an increased risk of infection, NEC, and mortality.
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