Population and Lifespan Sciences, School of Medicine, University of Nottingham, Nottingham, UK.
Dietetic Programme, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, 50300, Kuala Lumpur, Malaysia.
Pediatr Res. 2022 Aug;92(2):520-525. doi: 10.1038/s41390-021-01821-y. Epub 2021 Oct 29.
Current recommendations do not support the use of anti-reflux medications to treat gastro-oesophageal reflux disease (GORD) among preterm infants.
To describe the prevalence of GORD and the use of anti-reflux medications amongst very preterm infants (<32 weeks' gestational age (GA)) in neonatal units in England and Wales.
Retrospective cohort study using the National Neonatal Research Database.
Among 58,108 infants [median GA (IQR) 29 (27-30) weeks], 15.8% (n = 9191) had a diagnosis of GORD and 36.9% (n = 12,446) received anti-reflux medications. Those who received anti-reflux medications were more preterm [GA, median (IQR): medications, 28 (26-30) vs. no medications, 30 (28-31); p < 0.001] and had lower birth weight [mean (SD): medications, 1124 g (354) vs. no medications, 1265 g (384); p < 0.001]. Most (57%, n = 12,224) received Gaviscon, or Histamine-2 Receptor Antagonist (H2RA) (56%, n = 11,959). Over time, prokinetic use has declined substantially, the use of H2RAs and Gaviscon has reduced although they continue to be used frequently, whilst the use of PPIs has increased.
Anti-reflux medications are frequently prescribed in very preterm infants, despite evidence to suggest that they are not effective and may be harmful. Clear guidelines for diagnosing GORD and the use of anti-reflux medications are required to rationalise the pharmacological management of GORD in preterm infants.
Anti-reflux medications are frequently prescribed, often without a diagnosis of gastro-oesophageal reflux disease, to very preterm infants while in the neonatal unit and at discharge. Half of the infants born at <28 weeks' gestational age receive anti-reflux medications in hospital and a quarter are discharged home on them. Although the use of prokinetics declined following alerts of adverse events, histamine2-receptor antagonists and alginates such as Gaviscon continue to be used and the use of proton-pump inhibitors has increased more than 2-fold.
目前的建议不支持使用抗反流药物治疗早产儿胃食管反流病（GORD）。
描述英格兰和威尔士新生儿单位中非常早产儿（<32 周胎龄（GA））中 GORD 的患病率和抗反流药物的使用情况。
使用国家新生儿研究数据库的回顾性队列研究。
在 58108 名婴儿中[中位数 GA（IQR）29（27-30）周]，15.8%（n=9191）诊断为 GORD，36.9%（n=12446）接受了抗反流药物治疗。接受抗反流药物治疗的婴儿更早产[GA，中位数（IQR）：药物，28（26-30）vs. 无药物，30（28-31）；p<0.001]且出生体重更低[平均（SD）：药物，1124g（354）vs. 无药物，1265g（384）；p<0.001]。大多数（57%，n=12224）接受了 Gaviscon 或 H2 受体拮抗剂（H2RA）（56%，n=11959）。随着时间的推移，促动力药物的使用大幅下降，H2RA 和 Gaviscon 的使用虽然仍在频繁使用，但有所减少，而 PPI 的使用有所增加。
尽管有证据表明抗反流药物无效且可能有害，但非常早产儿仍经常开处方使用抗反流药物。需要制定明确的 GORD 诊断和抗反流药物使用指南，以合理规范早产儿 GORD 的药物治疗。
在新生儿病房和出院时，经常为非常早产儿开处方抗反流药物，而没有诊断胃食管反流病。一半出生于<28 周胎龄的婴儿在医院接受抗反流药物治疗，四分之一出院时在家中服用。尽管在不良反应警报后促动力药物的使用有所下降，但 H2 受体拮抗剂和 Gaviscon 等藻酸盐仍在使用，质子泵抑制剂的使用增加了两倍多。
