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Implementation of a Guideline to Decrease Use of Acid-Suppressing Medications in the NICU.

Asimenia Angelidou1,2, Katherine Bell2,3, Munish Gupta2,4

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Summary
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A new guideline significantly reduced nonindicated use of acid-suppressing medications like proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs) in newborns. This intervention lowered prescriptions without increasing complications, improving infant care.

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Area of Science:

  • Neonatal pharmacology
  • Evidence-based medicine
  • Quality improvement initiatives

Background:

  • Acid-suppressing medications, including proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), are widely used in neonatal intensive care units (NICUs).
  • Limited data exist on the efficacy and potential harms of these medications in newborns, leading to concerns about nonindicated use.
  • A level III/IV NICU aimed to decrease the prescription of PPIs and H2RAs in infants under one month corrected age.

Purpose of the Study:

  • To develop and implement a guideline to reduce the nonindicated use of PPIs and H2RAs in a neonatal intensive care unit.
  • To decrease monthly prescriptions of these acid-suppressing medications in infants <1 month corrected age from a baseline of 7.5 to 4 by December 2016.

Main Methods:

  • The study utilized plan-do-study-act cycles for guideline implementation and revision, including staff education.
  • Outcome measures included nonindicated and total monthly PPI/H2RA prescriptions, patient days with therapy, and secondary outcomes like potential complications and gastrointestinal bleeds.
  • Statistical process control charts and interrupted time series analysis compared outcomes over baseline and postimplementation periods.

Main Results:

  • Nonindicated PPI/H2RA prescriptions decreased significantly from a mean of 7.5 to 0 per month (P = .001).
  • Total PPI/H2RA prescriptions also decreased significantly from a mean of 11.5 to 2.5 per month (P = .002).
  • Rates of gastrointestinal bleeds and potentially related complications remained stable, indicating no increased harm.

Conclusions:

  • Implementing an evidence-based guideline effectively reduced nonindicated acid-suppressing medication use in the NICU.
  • This intervention successfully lowered the exposure burden of PPIs/H2RAs in neonates.
  • The guideline implementation is a feasible strategy for other similar inpatient settings to reduce unnecessary medication use.