267 - Reduction in Acid Suppression Therapy in Neonates – A Single Center Experience

Poster Number: 267
Publication Number: 267.131

Saivaroon Gajagowni, University of Missouri-Columbia School of Medicine, O'Fallon, MO, United States; Erin Martin, University of Missouri-Columbia School of Medicine, Columbia, MO, United States; Akshaya J. Vachharajani, University of Missouri-Columbia School of Medicine, Columbia, MO, United States

Background: The use of histamine-2 receptor antagonists (H2RA) and proton pump inhibitors (PPI) for treatment of gastroesophageal reflux disease (GERD) in infants has been associated with adverse effects. Studies have shown no correlation between acid reflux therapy for perceived signs of reflux in neonates and symptom improvement. Guidelines from the American Academy of Pediatrics (AAP) and other organizations have advocated for the cautious use of these medications. We undertook a project to establish evidence-based criteria for H2RA/PPI prescriptions.

Objective: The primary goal of this project was to advocate for the judicious use of AST and monitor trends in usage post intervention period at our institution.

Design/Methods: Education of faculty and staff at the NICU started in October of 2020 with an initial presentation of the AAP clinical report on diagnosis and management of GER in preterm infants. The report was deemed to focus on preterm neonates and providers did not change their prescribing practices as infants beyond 37 weeks were considered term. Hence, a second presentation, 3 months later, with a pediatric gastroenterologist discussed the European Society for Pediatric Gastroenterology and Nutrition (ESPGAN) recommendations against the use of AST. We then collected data on AST prescriptions in the NICU pre intervention (November 2018 – September 2020) and post intervention (November 2020 – September 2021). The primary outcomes of the study include total number of H2RA/PPI prescriptions and number of nonindicated PPI/H2RA prescriptions. Secondary outcomes include duration of use, gestational age at start of medication, and continuation of medication at discharge.

Results: AST was used in 3.9% of NICU babies in the pre-intervention group but decreased to 1.8% in the post-intervention period (P = .04). AST continues to be used for non-indicated conditions (P = .59). Median duration of usage in the pre-intervention group was 17.5 (IQR 7 - 30.3), gestational age of 39 (IQR 37 - 41.1), and 55% of individuals had the medication continued at discharge. In the post-intervention group, the median duration of usage was 9 (IQR 5 - 11), gestational age was 39 (IQR 37.6 - 48), and 25% of individuals had the medication continued at discharge.Conclusion(s): There was a statically and clinically significant decrease in AST usage post intervention. There also saw a reduction in AST being continued at discharge which likely led to a larger reduction in duration of use of AST in the outpatient setting although this was unable to be verified as families established care with new pediatricians.
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