Abstract
Although gastroesophageal reflux (GER) is a very common phenomenon among preterm infants, its therapeutic management is still an issue of debate among neonatologists. A step-wise approach should be advisable, firstly promoting nonpharmacological interventions and limiting drugs to selected infants unresponsive to the conservative measures or who are suffering from severe GER with clinical complications. Despite of this, a concerning pharmacological overtreatment has been increasingly reported. Most of the antireflux drugs, however, have not been specifically assessed in preterm infants; moreover, serious adverse effects have been noticed in association to their administration. This review mainly aims to draw the state of the art regarding the pharmacological management of GER in preterm infants, analyzing the best piecies of evidence currently available on the most prescribed anti-reflux drugs. Although further trials are required, sodium alginate-based formulations might be considered promising; however, data regarding their safety are still limited. Few piecies of evidence on the efficacy of histamine-2 receptor blockers and proton pump inhibitors in preterm infants with GER are currently available. Nevertheless, a significantly increased risk of necrotizing enterocolitis and infections has been largely reported in association with their use, thereby leading to an unfavorable risk-benefit ratio. The efficacy of metoclopramide in GER's improvement still needs to be clarified. Other prokinetic agents, such as domperidone and erythromycin, have been reported to be ineffective, whereas cisapride has been withdrawn due to its remarkable cardiac adverse effects.
Highlights
Gastroesophageal reflux (GER) is very frequent in preterm infants
This review mainly aims to draw the state of the art regarding the pharmacological management of gastroesophageal reflux (GER) in preterm infants, analyzing the best piecies of evidence currently available on the most prescribed antireflux drugs
We aimed to provide a complete overview on the pharmacological management of GER in preterm infants, analyzing the evidences currently available conceiving the most prescribed antireflux drugs: surface protective agents as alginatebased formulations, histamine-2 receptor blockers, proton pump inhibitors, and prokinetics
Summary
Gastroesophageal reflux (GER) is very frequent in preterm infants. The incidence in those babies born before 34 weeks of gestation approximately amounts to 22% [1]. A step-wise approach, which firstly promotes nonpharmacological interventions such as body positioning, modification of feeding modalities, or milk thickening, is currently considered an advisable strategy to manage GER in preterm infants [3, 6], limiting drug administration to those infants who do not benefit from conservative measures or with clinical complications of GER [8]. A widespread use of empirical antireflux medications in preterm infants, both during hospital recovery and after discharge, has been reported [9] Most of these drugs, have not been studied in these patients; antireflux medications have been noticed to cause serious adverse effects. We aimed to provide a complete overview on the pharmacological management of GER in preterm infants, analyzing the evidences currently available conceiving the most prescribed antireflux drugs: surface protective agents as alginatebased formulations, histamine-2 receptor blockers, proton pump inhibitors, and prokinetics
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