Neonatology and NICU, S Anna Hospital, AOU Città della Salute e della Scienza, Torino, Italy.
Neonatology and NICU, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain.
J Pediatr. 2018 Feb;193:62-67.e1. doi: 10.1016/j.jpeds.2017.09.080. Epub 2017 Dec 1.
To investigate whether exposure to inhibitors of gastric acidity, such as H2 blockers or proton pump inhibitors, can independently increase the risk of infections in very low birth weight (VLBW) preterm infants in the neonatal intensive care unit.
This is a secondary analysis of prospectively collected data from a multicenter, randomized controlled trial of bovine lactoferrin (BLF) supplementation (with or without the probiotic Lactobacillus rhamnosus GG) vs placebo in prevention of late-onset sepsis (LOS) and necrotizing enterocolitis (NEC) in preterm infants. Inhibitors of gastric acidity were used at the recommended dosages/schedules based on the clinical judgment of attending physicians. The distribution of days of inhibitors of gastric acidity exposure between infants with and without LOS/NEC was assessed. The mutually adjusted effects of birth weight, gestational age, duration of inhibitors of gastric acidity treatment, and exposure to BLF were controlled through multivariable logistic regression. Interaction between inhibitors of gastric acidity and BLF was tested; the effects of any day of inhibitors of gastric acidity exposure were then computed for BLF-treated vs -untreated infants.
Two hundred thirty-five of 743 infants underwent treatment with inhibitors of gastric acidity, and 86 LOS episodes occurred. After multivariate analysis, exposure to inhibitors of gastric acidity remained significantly and independently associated with LOS (OR, 1.03; 95% CI, 1.008-1.067; P = .01); each day of inhibitors of gastric acidity exposure conferred an additional 3.7% odds of developing LOS. Risk was significant for Gram-negative (P < .001) and fungal (P = .001) pathogens, but not for Gram-positive pathogens (P = .97). On the test for interaction, 1 additional day of exposure to inhibitors of gastric acidity conferred an additional 7.7% risk for LOS (P = .003) in BLF-untreated infants, compared with 1.2% (P = .58) in BLF-treated infants.
Exposure to inhibitors of gastric acidity is significantly associated with the occurrence of LOS in preterm VLBW infants. Concomitant administration of BLF counteracts this selective disadvantage.
isrctn.org: ISRCTN53107700.
研究抗胃酸药物（如 H2 受体阻滞剂或质子泵抑制剂）的暴露是否会独立增加新生儿重症监护病房极低出生体重（VLBW）早产儿感染的风险。
这是一项针对牛乳铁蛋白（BLF）补充（联合或不联合益生菌鼠李糖乳杆菌 GG）与安慰剂预防早产儿晚发性败血症（LOS）和坏死性小肠结肠炎（NEC）的多中心、随机对照试验的前瞻性数据的二次分析。抗胃酸药物的使用是根据主治医生的临床判断，按照推荐剂量/方案进行的。评估了 LOS/NEC 婴儿和无 LOS/NEC 婴儿之间抗胃酸药物暴露天数的分布。通过多变量逻辑回归控制出生体重、胎龄、抗胃酸药物治疗时间和 BLF 暴露的相互调整作用。测试了抗胃酸药物和 BLF 之间的相互作用；然后计算了任何一天的抗胃酸药物暴露对接受 BLF 治疗和未接受 BLF 治疗的婴儿的影响。
743 名婴儿中有 235 名接受了抗胃酸药物治疗，发生了 86 例 LOS 发作。多变量分析后，抗胃酸药物的暴露与 LOS 显著且独立相关（OR，1.03；95%CI，1.008-1.067；P=0.01）；每天接触抗胃酸药物会增加 3.7%的 LOS 发病风险。革兰氏阴性（P<0.001）和真菌（P=0.001）病原体的风险显著，但革兰氏阳性病原体的风险不显著（P=0.97）。在交互作用检验中，与 BLF 未治疗的婴儿相比，BLF 治疗的婴儿每多暴露 1 天抗胃酸药物，LOS 的风险增加 7.7%（P=0.003），而增加 1.2%（P=0.58）。
抗胃酸药物的暴露与 VLBW 早产儿 LOS 的发生显著相关。同时给予 BLF 可抵消这种选择性劣势。
isrctn.org：ISRCTN53107700。
