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Stress ulcer prophylaxis in children with status asthmaticus receiving systemic corticosteroids: a descriptive study

Anthony A Sochet1,2, Sorany Son1, Kelsey S Ryan1,3

  • 1Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.

The Journal of Asthma : Official Journal of the Association for the Care of Asthma
|May 4, 2019
PubMed

Insights

Stress ulcer prophylaxis (SUP) did not increase clinically important bleeding (CIB) in children hospitalized for status asthmaticus. Further research should assess bleeding risk factors before routine SUP administration in this pediatric population.

Area of Science:

  • Pediatric critical care medicine
  • Gastroenterology
  • Pharmacology

Background:

  • Status asthmaticus is a severe asthma exacerbation requiring hospitalization.
  • Stress ulcer prophylaxis (SUP) is sometimes used in critically ill children, but its benefit in status asthmaticus is unclear.
  • Clinically important bleeding (CIB) is a potential complication in hospitalized children.

Purpose of the Study:

  • To determine the frequency of CIB in children with status asthmaticus who received SUP versus those who did not.
  • To assess gastrointestinal complications and SUP-related adverse events in these cohorts.

Main Methods:

  • A single-center, retrospective cohort study of 217 children (aged 5-18 years) hospitalized for asthma exacerbation between May 2015 and May 2017.
  • Comparison of CIB frequency, gastrointestinal complications, and adverse events between children who received SUP and those who did not.
  • Analysis of a pediatric intensive care unit (PICU) subcohort to control for asthma severity and CIB risk factors.

Main Results:

  • Of 217 children, 92 (42%) received SUP, with 82 admitted to the PICU.
  • No significant differences in asthma severity or CIB risk factors were found between SUP and no-SUP groups in the PICU subcohort.
  • No instances of CIB or SUP-related adverse events were observed. Two patients in the no-SUP group developed gastritis, and one experienced occult gastrointestinal bleeding with spontaneous resolution.

Conclusions:

  • Children hospitalized for status asthmaticus, with or without SUP, showed no observed incidence of CIB.
  • The study suggests a need for prerequisite assessment of individual gastrointestinal bleeding risk factors before routine SUP administration in this pediatric population.
  • Current evidence does not support blanket SUP use in all children with status asthmaticus.

Keywords:
Pediatric intensive care unitgastritisgastrointestinal bleedingsteroids

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