Exposure to Gastric Acid Inhibitors Increases the Risk of Infection in Preterm Very Low Birth Weight Infants but Concomitant Administration of Lactoferrin Counteracts This Effect - 31/01/18
, Ruben García Sánchez, MD 2, Michael Meyer, MD 3, Ilaria Stolfi, MD 4, Lorenza Pugni, MD 5, Hubert Messner, MD 6, Silvia Cattani, MD 7, Pasqua Maria Betta, MD 8, Luigi Memo, MD 9, Lidia Decembrino, MD 10, Lina Bollani, MD 10, Matteo Rinaldi, MD 11, Maria Fioretti, MD 1, Michele Quercia, MD 12, Milena Maule, PhD 13, Elena Tavella, MD 1, Alessandro Mussa, MD 1, Chryssoula Tzialla, MD 10, Nicola Laforgia, MD 12, Fabio Mosca, MD, PhD 5, Rosario Magaldi, MD 11, Michael Mostert, MD, PhD 14, Daniele Farina, MD 1on behalf of the
Italian Task Force for the Study, and Prevention of Neonatal Fungal Infections and the Italian Society of Neonatology*
Abstract |
Objective |
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.
Study design |
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.
Results |
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.
Conclusion |
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.
Trial registration |
isrctn.org: ISRCTN53107700.
Le texte complet de cet article est disponible en PDF.Keywords : lactoferrin, VLBW neonates, Candida, infection, colonization, H2 blockers
Abbreviations : BLF, FOS, H2B, LGG, LOS, NEC, NICU, PPI, RCT, VLBW
Plan
| The authors declare no conflicts of interest. |
|
| Portions of this study were presented as an abstract at the Pediatric Academic Societies Meeting, April 30-May 3, 2015, San Diego, California. |
Vol 193
P. 62 - février 2018 Retour au numéro
Article précédent
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