Exposure to Gastric Acid Inhibitors Increases the Risk of Infection in Preterm Very Low Birth Weight Infants but...

Area of Science:

• Neonatal Medicine
• Pediatric Infectious Diseases
• Pharmacology

Background:

• Preterm infants, especially those with very low birth weight (VLBW), are susceptible to infections in the neonatal intensive care unit (NICU).
• Gastric acid inhibitors, including H2 blockers and proton pump inhibitors, are frequently used in neonates, but their independent impact on infection risk is not fully understood.
• Late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) are significant concerns in preterm infants.

Purpose of the Study:

• To determine if exposure to gastric acid inhibitors independently elevates the risk of infections in VLBW preterm infants.
• To investigate the potential protective role of bovine lactoferrin (BLF) against infections in this vulnerable population.
• To analyze the interaction between gastric acid inhibitor use and BLF supplementation in the context of LOS.

Main Methods:

• Secondary analysis of prospectively collected data from a multicenter randomized controlled trial involving BLF and/or Lactobacillus rhamnosus GG supplementation versus placebo.
• Multivariable logistic regression was employed to assess the independent effects of gastric acid inhibitor exposure, adjusting for factors like birth weight, gestational age, and BLF treatment.
• The study specifically examined the association between the duration of gastric acid inhibitor exposure and the occurrence of LOS, and tested for interaction with BLF.

Main Results:

• Exposure to gastric acid inhibitors was significantly and independently associated with an increased risk of LOS (OR, 1.03 per day of exposure; P=.01).
• Each additional day of gastric acid inhibitor use conferred a 3.7% increased odds of developing LOS, particularly for Gram-negative and fungal pathogens.
• Concomitant BLF administration significantly mitigated the increased LOS risk associated with gastric acid inhibitors; the risk increase per day was 7.7% in untreated infants versus 1.2% in BLF-treated infants.

Conclusions:

• Exposure to gastric acid inhibitors is a significant risk factor for LOS in VLBW preterm infants.
• Bovine lactoferrin (BLF) supplementation demonstrates a protective effect, counteracting the increased susceptibility to LOS induced by gastric acid inhibitors.
• These findings suggest a potential therapeutic strategy involving BLF to mitigate infection risks in preterm infants receiving gastric acid inhibitors.