Exposure to H2 receptor antagonists may be associated with increased risk of NEC and infections in preterm infants
BACKGROUND Inhibitors of gastric acid ( IGA ) are used for upper gastrointestinal bleeding or gastroesophageal reflux in preterm infants .
The result ant increase in gastric pH may enhance the growth of pathogens and increase the risk of necrotizing enterocolitis ( NEC ) .
Our systematic review examined the association between  IGA and NEC in preterm infants .
High prevalence of asymptomatic esophageal and gastric lesions in preterm infants in intensive care
To establish the prevalence of upper gastrointestinal mucosal lesions in full-term and preterm infants under stress . Design : A prospect i ve , cohort study . Setting : Neonatal intensive care unit at a university teaching hospital . Patients : Seventeen ( 14 preterm , 3 term ; median gestational age 29.7 wks ; median birth weight 1230 g ) consecutive , unselected infants treated in intensive care . Interventions : Gastroscopy , using a prototype fiberoptic gastroscope design ed for newborns , was performed for the first time at the age of 3 to 7 days . Biopsy specimens were taken when possible . Ranitidine treatment and follow-up endos-copies were performed in selected patients . Blood pressure , heart rate , oxygen saturation by pulse oximeter , and the general condition of the infants were monitored at 1-min intervals during the endoscopy .  Central nervous system ultra-sonography examination was repeatedly performed before and after the procedure . Measurements and Main Results : At the time of first endoscopy , 15 of 17 infants were asymptomatic for gastrointestinal tract problems , one had melena , and one hematemesis . Upper gastrointestinal endoscopy revealed pathology in 16 ( 94 % ) infants , macroscopic esophagitis in six infants , hemorrhagic gastritis in nine infants , and gastritis with ulcers in six infants . Microscopically , the lesions were also clear . A peculiar finding was acute gastritis with cystic gl and deformation ( “ cystic gastritis ” ) seen in five of the infants under stress ; one of these infants also had intestinal metaplasia in the gastric mucosa . Seven infants were treated with ranitidine without side-effects . Follow-up endoscopies demonstrated normalization of the lesions in five of six infants studied . The procedure , including biopsies , seemed to be safe , even for very low-birth weight infants . Conclusions : Gastric mucosal lesions are highly prevalent in preterm infants in intensive care before any symptoms occur . Further research on preterm infants under stress is needed in order to determine the risk factors and optimal treatment for the esophageal and gastric mucosal lesions described here . ( Crit Care Med 1993 ; 21:1863–1867
Exposure to H2 receptor antagonists may be associated with increased risk of NEC and infections in preterm infants
BACKGROUND Inhibitors of gastric acid ( IGA ) are used for upper gastrointestinal bleeding or gastroesophageal reflux in preterm infants .
The result ant increase in gastric pH may enhance the growth of pathogens and increase the risk of necrotizing enterocolitis ( NEC ) .
Our systematic review examined the association between  IGA and NEC in preterm infants .