1. 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
- Author
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Paolo Manzoni, Ruben García Sánchez, Michael Meyer, Ilaria Stolfi, Lorenza Pugni, Hubert Messner, Silvia Cattani, Pasqua Maria Betta, Luigi Memo, Lidia Decembrino, Lina Bollani, Matteo Rinaldi, Maria Fioretti, Michele Quercia, Milena Maule, Elena Tavella, Alessandro Mussa, Chryssoula Tzialla, Nicola Laforgia, Fabio Mosca, Rosario Magaldi, Michael Mostert, Daniele Farina, Amelia Di Comite, Alessandro Borghesi, Giovanni Agriesti, Riccardo Arisio, Caterina Franco, Roberta Guardione, Elena Boano, Alessia Catarinella, Cristina Romano, Cesare Monetti, Ugo Sala, Caterina Carbonara, Emmanuele Mastretta, Paola Del Sordo, Claudio Priolo, Paolo Galletto, Francesca Campagnoli, Mauro Vivalda, Giuseppina Bonfante, Giovanna Gomirato, Davide Montin, Roberta Camilla, Alessandro Messina, Marta Pieretto, Domenico Cipolla, Mario Giuffrè, Giovanni Corsello, Fabio Natale, Gennaro Vetrano, Elisabetta Tridapalli, Giacomo Faldella, Maria Grazia Capretti, PierMichele Paolillo, Simonetta Picone, Serafina Lacerenza, Giancarlo Gargano, Cristiana Magnani, Onofrio Sergio Saia, Elena Della Casa, Manzoni, Paolo, García Sánchez, Ruben, Meyer, Michael, Stolfi, Ilaria, Pugni, Lorenza, Messner, Hubert, Cattani, Silvia, Betta, Pasqua Maria, Memo, Luigi, Decembrino, Lidia, Bollani, Lina, Rinaldi, Matteo, Fioretti, Maria, Quercia, Michele, Maule, Milena, Tavella, Elena, Mussa, Alessandro, Tzialla, Chryssoula, Laforgia, Nicola, Mosca, Fabio, Magaldi, Rosario, Mostert, Michael, Farina, Daniele, Giuffrè, Mario, Corsello, Giovanni, Manzoni P, García Sánchez R, Meyer M, Stolfi I, Pugni L, Messner H, Cattani S, Betta PM, Memo L, Decembrino L, Bollani L, Rinaldi M, Fioretti M, Quercia M, Maule M, Tavella E, Mussa A, Tzialla C, Laforgia N, Mosca F, Magaldi R, Mostert M, Farina D, and Di Comite A, Borghesi A, Agriesti G, Arisio R, Franco C, Guardione R, Boano E, Catarinella A, Romano C, Monetti C, Sala U, Carbonara C, Mastretta E, Del Sordo P, Priolo C, Galletto P, Campagnoli F, Vivalda M, Bonfante G, Gomirato G, Montin D, Camilla R, Messina A, Pieretto M, Cipolla D, Giuffrè M, Corsello G, Natale F, Vetrano G, Tridapalli E, Faldella G, Capretti MG, Paolillo P, Picone S, Lacerenza S, Gargano G, Magnani C, Sergio Saia O, Della Casa E
- Subjects
Colonization ,Proton Pump Inhibitor ,Neonatal intensive care unit ,Administration, Oral ,Histamine H2 Antagonist ,Probiotic ,Gastroenterology ,Pediatrics ,H2 blocker ,0302 clinical medicine ,Risk Factors ,Infant, Very Low Birth Weight ,030212 general & internal medicine ,Candida ,VLBW neonate ,Lacticaseibacillus rhamnosus ,Gestational age ,Perinatology and Child Health ,Histamine H2 Antagonists ,Italy ,Necrotizing enterocolitis ,medicine.symptom ,Infection ,Infant, Premature ,Human ,medicine.medical_specialty ,Birth weight ,Gastric Acid ,Sepsis ,03 medical and health sciences ,Enterocolitis, Necrotizing ,Intensive Care Units, Neonatal ,030225 pediatrics ,Internal medicine ,medicine ,H2 blockers ,Humans ,Dietary Supplement ,business.industry ,Risk Factor ,Probiotics ,Infant, Newborn ,Proton Pump Inhibitors ,medicine.disease ,Low birth weight ,Lactoferrin ,Concomitant ,Dietary Supplements ,Pediatrics, Perinatology and Child Health ,VLBW neonates ,Gastric acid ,Lactobacillus rhamnosu ,business ,New Zealand - 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.
- Published
- 2018