Poster Session II - A198 TEMPORAL TRENDS IN ANTI-REFLUX MEDICATION USE IN VERY PRETERM INFANTS: A POPULATION-BASED COHORT STUDY

TL;DR

This study examines how often anti-reflux medications are used in very preterm infants over time and finds that their use remains high despite recent guidelines discouraging routine use.

Contribution

The study provides population-based evidence on the temporal trends of anti-reflux medication use in very preterm infants across NICU and community settings.

Findings

ARM use decreased over time but remained high at 35.1% in the most recent period.

Proton pump inhibitors became more common, while H2RAs and prokinetics declined.

High ARM use persisted in community settings after NICU discharge.

Abstract

Gastroesophageal reflux disease (GERD) affects up to 22% of infants born before 34 weeks’ gestation. Diagnosis is challenging and often relies on clinical judgment, as no standardized test can reliably rule out acid reflux. Management options include a trial of anti-reflux medications (ARMs) such as histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs). Recent guidelines discourage routine ARM use in pediatric population due to limited efficacy and potential health risks. Understanding prescribing patterns over time across both health care settings, in NICU and community, is key to reduce unnecessary ARM exposure in preterm infants.

To describe temporal trends in ARM use during the first six months of life in very preterm infants.

A retrospective population-based cohort study, using the provincial Perinatal Follow-Up Program database, was conducted. The study included all infants born at < 31 weeks gestational age between 2005 and 2023, excluding those with chromosomal or congenital anomalies, or neonatal deaths. Descriptive statistics and Chi-Square tests were used.

A total of 952 infants were enrolled. Of them, 445 (46.7%) infants were prescribed ARMs within the first six months of life (of these, 65.8% infants were prescribed in the NICU). Over the study period, ARM use decreased significantly but remained high at 35.1% in the last epoch. The prescription of H2 receptor antagonists, prokinetics, and combination therapies declined, whereas the use of proton-pump inhibitors rose over time (from 2.6% to 33.3%). The use of ARMs in the NICU decreased over time but remained common in community settings following NICU discharge.

The continued frequent use of ARMs among very preterm infants remains concerning, given the contrast with recent clinical care guidelines. While the reduction in NICU-initiated ARM prescriptions indicates positive progress and guideline adherence, the ongoing high rates of post-discharge use suggest persistent gaps in continuity of care and knowledge translation. These findings highlight the need for targeted education for both NICU and community care providers to reduce unnecessary exposure and improve alignment with evidence-based practice.

A198 Table 1: Anti-reflux medication use in the first 6 months of life, over time, and by type. Infants grouped by birth year into 4 categories.

Prokinetic medications were never used as a single agent.

p-value < 0.05.

Funding Agencies: None