Prescribing Practices of Oral Anti-Reflux Medications in the Neonatal Population

POSTER

Prescribing Practices of Oral Anti-Reflux Medications in the Neonatal Population Cat Worman DNP-NNP Student Contributions and expertese proficed by: Project Chair Julieanne Schiefelbein, DNP and Tracy Karp, MS, NNP-BC METHODS PURPOSE RESULTS • Design: Retrospective Cohort Study Design To examine the current practices in the prescribing of oral histamine-2 receptor and agonists(H2RA) and proton pump inhibitor (PPI) in a local level four •xs newborn intensive care unit (NICU) • Participants: NICU infants from one free standing children’s hospital from January 1, 2016 to July 1, 2016 • Data: Frequency of oral H2RA/PPI prescription, days of drug exposure, indication for drug initiation, total drug exposure (mg) and percent of infants remaining on treatment at discharge. GER: Gastroesophageal reflux TEF: Tracheal Esophageal Fistula EA: Esophageal Atresia CDH: Congenital Diaphragmatic Hernia • Use of these medications in preterm infants have been associated many sequelae including increased infections, candidemia and necrotizing enterocolitis. CONCLUSIONS TEF/EA 9% Key Graphic • Acid prophylaxis is clinically diagnosed and clinically managed with drugs that have significant side effects. Aspirin Therapy 8% • Despite lacking evidence of effectiveness, H2RAs and PPIs continue to be prescribed to preterm neonates and those with congenital anomalies and continued through discharge. Steroids 1% 25%ile • Guidelines have cautioned against the use of acid suppression medications in neonates. • Current usage remains wide spread and variable. • The majority of infants treated 78% (n=58) remained on therapy at discharge. On average, infants were exposed to an acid suppression drug for 31 days. Reason for Drug Therapy Initiation BACKGROUND • H2RAs/PPI are associated with adverse effects. • Between January 1, 2016 and July 1, 2016, 478 infants were admitted. Of the 478 infants, 16% (n=74) received an oral H2RA or PPI. Of these, 85% received a PPI (n=62) and 31% (n=23) received an H2RA; 84% (n= 62) had single drug exposure and 12 (16%) infants had dual drug exposure. 75%ile Total Days Of Drug Exposure 68 5 11 19 44 101 Graphic 127 161 185 • My findings support the need to initiate formalized methods of drug initiation and length of treatment in the neonatal population.