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Proton pump inhibitor administration in neonates and infants. Lack of consensus - An ASPO survey

Gil Zoizner-Agar1, Janine M Rotsides1, Qianhui Shao1

  • 1NYU Langone Health, Department of Otolaryngology-Head and Neck Surgery, NY, NY, USA.

International Journal of Pediatric Otorhinolaryngology
|July 18, 2020
PubMed

Insights

Pediatric otolaryngologists lack consensus on using proton-pump inhibitors (PPIs) for infant reflux. Current practice varies widely in dosage, frequency, and treatment line, highlighting the need for clear GER and LPR management guidelines.

Area of Science:

  • Pediatric Otolaryngology
  • Gastroenterology
  • Pharmacology

Background:

  • Laryngopharyngeal reflux (LPR) and gastroesophageal reflux (GER) present with non-specific symptoms in children, with unknown prevalence.
  • Proton-pump inhibitor (PPI) use is increasing, but lacks clear guidelines, efficacy data, and has safety concerns.
  • Physicians rely on anecdotal evidence for treating pediatric reflux conditions.

Purpose of the Study:

  • To evaluate practice patterns of pediatric otolaryngologists concerning PPI use for reflux-related conditions in infants.
  • To identify variations in prescribing habits for PPIs in newborns and infants.

Main Methods:

  • A survey was distributed to members of the American Society of Pediatric Otolaryngology (ASPO).
  • The survey assessed practice patterns for PPI use in neonates and infants (10 weeks to 1 year).
  • Statistical analysis, including Fisher's exact test, was employed.

Main Results:

  • 37% of respondents would not prescribe oral PPIs in neonates; 50% would not prescribe IV PPIs.
  • 60% would use PPIs as second or third-line treatment for infants, with only 10% using it as first-line.
  • 48% prescribed PPIs once daily, and 19% twice daily, with no practice differences based on experience or patient volume.

Conclusions:

  • No consensus exists on PPI dosage, frequency, or duration for infant reflux disease.
  • Physician experience or practice setting did not correlate with prescribing patterns.
  • A multidisciplinary approach and consensus statement are needed to guide GER and LPR management in pediatric populations.
Abstract

Keywords:
Gastroesophageal refluxLaryngopharyngeal refluxNeonatesProton-pump inhibitors

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