677 - Medical Treatment of Gastroesophageal Reflux in the Neonatal Intensive Care Unit: Current Practice

Gastroesophageal reflux disease (GERD) is a frequent concern in the care of neonates. Treatment includes acid-suppressive therapies, but there is significant practice variation given concerns about safety and efficacy. We sought to evaluate the current prescribing practice of acid-suppressive therapies among extremely preterm infants in the neonatal intensive care unit (NICU).


Objective:

To determine the prevalence and duration of acid-suppressive therapy use among preterm infants admitted to the NICU.


Design/Methods:

We performed a cohort study of infants 22 to 27 weeks gestational age (GA) who were discharged from Pediatrix Medical Group NICUs between 2015 and 2020. We excluded infants with major congenital anomalies and those who were transferred or died prior to discharge. We used summary statistics to evaluate use of acid-suppressive therapies across GAs, birthweights (BW), and commonly associated diagnoses, and used chi-square tests to compare acid-suppressive therapy use by demographics and diagnosis. Outcomes of interest included percent of infants receiving acid-suppressive therapies, duration of medication use, and use at the time of discharge.

Results:

13,735 infants from 202 NICUs met inclusion criteria. Median (25^th- 75^th percentile) GA and birthweight were 26 (25-27) weeks and 820 (670-970) grams, respectively. Of the total cohort, 1489 (11%) infants were exposed to any acid-suppressive therapies (Table 1). Exposed infants had lower BW, and a larger percentage were small for gestational age (Table 1, p< 0.001). 42% of the infants exposed to an acid-suppressive medication carried a GERD diagnosis (Table 1, p< 0.001). There was a greater percentage of NEC (7%) and bloodstream infections (20%) in the medication exposed group (Table 1, p< 0.001). More infants were exposed to H2 receptor antagonists (66%) compared to proton pump inhibitors (34%) (Table 2). There was no significant difference in type of therapy by GA (Table 2, p=0.24). 3% of exposed infants received doses on discharge day (Table 2).  The therapy duration was 8 days for most GAs (Table 2). There was a decrease in use overall during the 5-year period (Figure 1, p< 0.001).


Conclusion(s):

Acid-suppressive therapies are used commonly in preterm infants. Acid-suppressive medication receipt is higher in infants with lower BWs. The use of acid-suppressive therapies appears to be targeted, with many infants receiving them for one-week courses and without a diagnosis of GERD. Further study is required to guide safe use.