Abstract
Gastric acidity plays an important role in the protection of infants against various pathogens from the environment. The histamine-2 receptor blockers (H2-blockers) are off-labeled drugs that are frequently prescribed in preterm neonates to prevent stress ulcers. The impact of the H2-blockers on the development of the necrotizing enterocolitis (NEC) in preterm infants is still controversial, particularly in the developing world. One hundred twenty-two preterm infants were enrolled in the study. The multivariate logistic regression model was used to identify potential postnatal risk factors associated with NEC. Preterm infants (n = 51) with total NEC, medical NEC, and surgical NEC had the highest rate of receiving ranitidine compared with controls (n = 71) (39.2%, 19.6%, and 47.6%, p < 0.05). Logistic regression analysis revealed that ranitidine use and nosocomial infections were significantly associated with NEC development (odds ratios 1.55 and 3.3). We confirm that ranitidine administration was associated with an increased risk of NEC in preterm infants. H2-blockers use should be only administered in very strictly selected cases after careful consideration of the risk-benefit ratio.
Highlights
Gastric acidity plays an important role in the protection of infants against various pathogens from the environment
Prescription of inhibitors of gastric acid secretion (IGAS)/histamine-2 receptor blockers (H2-blockers) in preterm infants has been a widespread practice in the neonatal intensive care units (NICUs) because H2-blockers may prevent the gastric bleeding
We investigated the relationship between H2-blockers use and the development of necrotizing enterocolitis (NEC) in a pediatric population originating from a middle-income population (Bosnia and Herzegovina)
Summary
Gastric acidity plays an important role in the protection of infants against various pathogens from the environment. Despite many advances in the treatment of vulnerable preterm infants, necrotizing enterocolitis (NEC) remains the most common gastrointestinal tract emergency in the neonatal period with a substantial morbidity and a mortality rate [1,2,3]. These rates may be substantially higher in developing countries [4,5,6,7]. Gastric acidity is considered a major non-immune defense barrier against infections in neonates through the reduction of the number of ingested bacteria It reduces the possibility of bacterial dissemination into the bloodstream via an immature and leaky gut barrier [11]. Singh et al could not confirm an association between H2-blockers administration and an increased risk of infection and NEC in preterm infants [19]
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