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H2-Blockers Associated with NEC
Guillet R, Stoll BJ, Cotten, CM, et al. Association of H2-Blocker Therapy and Higher Incidence of Necrotizing Enterocolitis in Very Low Birth Weight Infants. PEDIATRICS (doi:10.1542/peds. 2005-1543) Published online January 3, 2006. [Full Text]
Objective. We sought to determine if an association exists between the use of histamine-2 receptor (H2) blockers and the incidence of necrotizing enterocolitis (NEC) in infants of 401 to 1500 g in birth weight.
Study Design. Data from the National Institute of Child Health and Human Development Neonatal Research Network very low birth weight (401–1500 g) registry from September 1998 to December 2001 were analyzed. The relation between the diagnosis of NEC (Bell stage II or greater) and antecedent H2-blocker treatment was determined by using case-control methodology. Conditional logistic regression was implemented, controlling for gender, site of birth (outborn versus inborn), Apgar score of <7 at 5 minutes, and postnatal steroids.
Results. Of 11072 infants who survived for at least 12 hours, 787 (7.1%) developed NEC (11.5% of infants 401–750 g, 9.1% of infants 751–1000 g, 6.0% of infants 1001–1250 g, and 3.9% of infants 1251–1500 g). Antecedent H2-blocker use was associated with an increased incidence of NEC (P < .0001).
Conclusions. H2-blocker therapy was associated with higher rates of NEC, which is in agreement with a previous randomized trial of acidification of infant feeds that resulted in a decreased incidence of NEC. In combination, these data support the hypothesis that gastric pH level may be a factor in the pathogenesis of NEC.
Comments. In this study, the relative risk for NEC was 1.71x
higher in VLBW infants who were treated with H2-blockers. In an earlier
report, Beck-Sague
[Medline] reported that the risk of blood stream infections in NICU
patients was 4.2x higher if they were receiving H2-blockers. The use of
ranitidine (Zantac) or other H2-blockers in preterm infants should be limited
until more data concerning its safety in this population is available. ABK
Date: 23 Jan 2006
Time: 03:26:32
considering which h2, blocking, inmunologíco in general depresses the system, we think that the indiscriminate and routine use of these complica but to our patients
UserName:
monica sanchez
Institution: imss bcs neonatologia
telephone:
email: mcsaynes@hotmail.com
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