Evidence insufficient for antacid treatment in preterm infants
There is limited evidence supporting the use of antacid therapy in preterm infants with gastro-oesophageal reflux disease (GERD), according to a study.
Researchers conducted a systematic review of studies evaluating the efficacy and safety of histamine-2 receptor antagonists, proton pump inhibitors and alginates vs placebo in preterm infants (<37 weeks gestation) with GERD. They identified a total of six studies involving 302 patients.
A meta-analysis could not be performed owing to a lack of studies evaluating the same intervention with the same outcomes. Data showed that omeprazole therapy markedly decreased the oesophageal acid exposure percentage time with pH <4 (p<0.01) but did not alter GERD symptoms. Sodium alginate significantly reduced gastro-oesophageal reflux episodes (p=0.024).
Meanwhile, the combination of metoclopramide and ranitidine appeared counterintuitive, producing a significant increase in GERD symptoms and resulting in more bradycardia episodes compared with placebo.
No significant results were found for treatment with esomeprazole or lansoprazole vs placebo.
The studies included were heterogeneous with respect to design, study characteristics such as age of participants, and interventions considered for the treatment of GERD. Moreover, sample sizes were small. These factors limit the conclusions that can be drawn from the present review, as well as highlight the gaps in the evidence, researchers said.
As more studies are required to further examine the use of antacids in preterm infants with GERD, caution should be taken when administering these drugs, they added.