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Common reflux treatment linked to life threatening bowel infection in premature infants
February 09, 2006Researchers in an NIH network have found that premature infants given a common class of non-prescription drugs used to treat acid reflux are slightly more likely to develop a potentially fatal bowel disorder than are infants who are not treated with the drugs.
The drugs, known as H2 blockers, inhibit the production of stomach acid and may put premature infants at risk of necrotizing enterocolitis, a serious inflammation of the intestines. The study appears in the February 2006 Pediatrics and was conducted by researchers in the NIH's National Institute of Child Health and Human Development Neonatal Research Network.
The researchers pointed out that it is not possible to tell from the study whether or not the drugs caused the condition, but nonetheless advised caution with their use for premature infants.
"This study strongly suggests that the current practice of prescribing H2 blockers to prevent or treat acid reflux in premature infants needs to be carefully reevaluated by all concerned in light of these new findings," said Elias A. Zerhouni, M.D., Director of the National Institutes of Health.
Necrotizing enterocolitis affects from 5 to 10 percent of infants born extremely prematurely, explained the study's first author, Ronnie Guillet, M.D., Ph.D., of the University of Rochester in Rochester, New York, a member institution of the NICHD Neonatal Research Network.
With necrotizing enterocolitis, tissue lining the wall of the intestines dies. The surviving tissue becomes swollen and inflamed, and the digestive tract is unable to digest or transport food. In some cases, damage to the intestines may require that portions of the intestines be removed. In other cases, the damage is so severe that the infant dies. The cause of the disorder is unknown.
Common H2 blockers are cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac), and nizatidine (Axid).
To conduct the study, Dr. Guillet and her coworkers analyzed the records of more than 11,000 very low birth weight infants who had been treated in the NICHD Neonatal Research Network. Of these, 787 premature infants had developed necrotizing enterocolitis. The infants ranged in weight from 401 grams to 1500 grams (about 14 ounces to just over 3 lbs). The researchers found that infants who received H2 blockers were 1.71 times more likely to develop necrotizing enterocolitis than were infants who had not received them.
In their article, Dr. Guillet and her coauthors wrote that it is not possible to determine from the analysis whether or not H2 blockers cause necrotizing enterocolitis. Another possible explanation, they wrote, is that infants likely to develop necrotizing enterocolitis might also have symptoms that require treatment with H2 blockers. The records that the researchers analyzed did not contain information on why physicians prescribed the drugs.
No other studies have been conducted on large numbers of premature infants receiving H2 blockers, said the program scientist of the NICHD Neonatal Research Network, Rosemary Higgins, M.D., of NICHD's Pregnancy and Perinatology Branch. However, the practice is widespread in neonatal intensive care units around the country.
Physicians prescribe H2 blockers to premature infants for several reasons, Dr. Higgins said. If premature infants are experiencing a lot of acid reflux, physicians might prescribe the drugs to prevent damage to the esophagus.
Dr. Higgins added that some physicians may prescribe H2 blockers to a premature infant who is not experiencing reflux out of concern that excessive stomach acid may lead to stomach ulcers. Some physicians believe that reflux may predispose an infant to apnea-the cessation of breathing during sleep. Dr. Higgins said that this belief is controversial and no research has been conducted to determine its validity. In other cases, physicians may prescribe H2 blockers to prevent excess stomach acidity among infants who, because they are unable to feed unassisted, must be fed through a tube inserted through the esophagus.
In the paper, Dr. Guillet and her coworkers hypothesized that, by decreasing acidity in the digestive tract, H2 blockers might result in excessive levels of a type of bacteria known as gram negative bacteria. These high bacterial levels, in turn, might lead to necrotizing entercolitis. The gram negative bacteria, normally harmless, are presumably kept in check by stomach acid, and might increase to unhealthy levels in the absence of sufficient stomach acid.
In support of their hypothesis, the researchers cited a study which found that experimental animals with reduced stomach acid levels had higher levels of gram negative bacteria and a high likelihood of developing necrotizing enterocolitis. The researchers also cited a study which found that premature infants fed human milk with a slightly higher acidity level than normal had lower levels of gram negative bacteria and were less likely to develop necrotizing enterocolitis than were infants fed milk with a normal acidity level.
The researchers did not study any other drugs used to reduce stomach acidity and do not know whether premature infants given these drugs have an increased likelihood of necrotizing enterocolitis.
NIH/National Institute of Child Health and Human Development
"This study strongly suggests that the current practice of prescribing H2 blockers to prevent or treat acid reflux in premature infants needs to be carefully reevaluated by all concerned in light of these new findings," said Elias A. Zerhouni, M.D., Director of the National Institutes of Health.
Necrotizing enterocolitis affects from 5 to 10 percent of infants born extremely prematurely, explained the study's first author, Ronnie Guillet, M.D., Ph.D., of the University of Rochester in Rochester, New York, a member institution of the NICHD Neonatal Research Network.
With necrotizing enterocolitis, tissue lining the wall of the intestines dies. The surviving tissue becomes swollen and inflamed, and the digestive tract is unable to digest or transport food. In some cases, damage to the intestines may require that portions of the intestines be removed. In other cases, the damage is so severe that the infant dies. The cause of the disorder is unknown.
Common H2 blockers are cimetidine (Tagamet), famotidine (Pepcid), ranitidine (Zantac), and nizatidine (Axid).
To conduct the study, Dr. Guillet and her coworkers analyzed the records of more than 11,000 very low birth weight infants who had been treated in the NICHD Neonatal Research Network. Of these, 787 premature infants had developed necrotizing enterocolitis. The infants ranged in weight from 401 grams to 1500 grams (about 14 ounces to just over 3 lbs). The researchers found that infants who received H2 blockers were 1.71 times more likely to develop necrotizing enterocolitis than were infants who had not received them.
In their article, Dr. Guillet and her coauthors wrote that it is not possible to determine from the analysis whether or not H2 blockers cause necrotizing enterocolitis. Another possible explanation, they wrote, is that infants likely to develop necrotizing enterocolitis might also have symptoms that require treatment with H2 blockers. The records that the researchers analyzed did not contain information on why physicians prescribed the drugs.
No other studies have been conducted on large numbers of premature infants receiving H2 blockers, said the program scientist of the NICHD Neonatal Research Network, Rosemary Higgins, M.D., of NICHD's Pregnancy and Perinatology Branch. However, the practice is widespread in neonatal intensive care units around the country.
Physicians prescribe H2 blockers to premature infants for several reasons, Dr. Higgins said. If premature infants are experiencing a lot of acid reflux, physicians might prescribe the drugs to prevent damage to the esophagus.
Dr. Higgins added that some physicians may prescribe H2 blockers to a premature infant who is not experiencing reflux out of concern that excessive stomach acid may lead to stomach ulcers. Some physicians believe that reflux may predispose an infant to apnea-the cessation of breathing during sleep. Dr. Higgins said that this belief is controversial and no research has been conducted to determine its validity. In other cases, physicians may prescribe H2 blockers to prevent excess stomach acidity among infants who, because they are unable to feed unassisted, must be fed through a tube inserted through the esophagus.
In the paper, Dr. Guillet and her coworkers hypothesized that, by decreasing acidity in the digestive tract, H2 blockers might result in excessive levels of a type of bacteria known as gram negative bacteria. These high bacterial levels, in turn, might lead to necrotizing entercolitis. The gram negative bacteria, normally harmless, are presumably kept in check by stomach acid, and might increase to unhealthy levels in the absence of sufficient stomach acid.
In support of their hypothesis, the researchers cited a study which found that experimental animals with reduced stomach acid levels had higher levels of gram negative bacteria and a high likelihood of developing necrotizing enterocolitis. The researchers also cited a study which found that premature infants fed human milk with a slightly higher acidity level than normal had lower levels of gram negative bacteria and were less likely to develop necrotizing enterocolitis than were infants fed milk with a normal acidity level.
The researchers did not study any other drugs used to reduce stomach acidity and do not know whether premature infants given these drugs have an increased likelihood of necrotizing enterocolitis.
NIH/National Institute of Child Health and Human Development
Necrotizing Enterocolitis Current Events and Necrotizing Enterocolitis News RSSRadiologists develop scale to help clinicians predict disease severity in infants with NEC
Radiologists at Duke University Medical Center have developed a scale called the Duke Abdominal Assessment Scale (DAAS) to assist clinicians in determining the severity of disease and the need for surgery in infants with necrotizing enterocolitis (NEC).
Packard/Stanford study suggests two causes for bowel disease in infants
New research from Lucile Packard Children's Hospital and the Stanford University School of Medicine is helping physicians unravel the cause of a deadly and mysterious bowel disease that strikes medically fragile newborn babies.
Children's Hospital researchers identify molecular 'switch' that could save very young lives
A team of researchers at Children's Hospital of Pittsburgh of UPMC have identified a molecular "switch" that, when blocked, may help reverse necrotizing enterocolitis (NEC), a leading cause of death in premature infants.
Leading cause of death in 'preemies' might be controlled by resetting a molecular switch
Blocking signals from a key molecular receptor that normally switches on the intestine's immune response but instead becomes too intense in the presence of stress and toxins may help reverse necrotizing enterocolitis (NEC), a leading cause of death in premature newborns.
Pathway to cell death redefined in landmark study
A new study led by investigators from the University of Pittsburgh School of Medicine demonstrates that the process of necrosis, long thought to be a chaotic, irreversible pathway to cell death, may actually be triggered as part of a regulated response to stress by a powerful protein, SRP-6, that can potentially halt necrosis in its path.
Two very different surgical procedures produce same results in often fatal intestinal disorder
Two surgical procedures, one invasive and the other much less so, for premature infants with intestinal perforation due to necrotizing enterocolitis (NEC) produce virtually identical results, according to a Yale School of Medicine study published today in the New England Journal of Medicine.
First trial on life-threatening condition finds 2 surgical approaches have same results
A nationwide clinical trial involving researchers at Children's Hospital of Pittsburgh compared two radically different surgical procedures to treat an often fatal intestinal disorder in premature infants and found nearly identical results.
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Necrotizing enterocolitis: An entry from Thomson Gale's Gale Encyclopedia of Children's Health: Infancy through Adolescence by Caroline Helwick (Author), Deborah, MS Nurmi (Author) Avoiding hard-to-understand medical jargon, the four-volume “Gale Encyclopedia of Children’s Health” uses language that parents can understand, while still providing enough depth to benefit today's health science students. The set provides in-depth coverage of pediatric diseases and disorders, along with issues related to physical and cognitive/behavioral development. | |
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Neonatal necrotizing enterocolitis (Monographs in neonatology) by Grune & Stratton (Publisher) | |
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Gale Encyclopedia of Medicine: Necrotizing enterocolitis by Caroline A. Helwick (Author) The article is excerpted from Gale Encyclopedia of Medicine. Consult the second edition of this authoritative, comprehensive, in-depth medical guide for information on more than 1,700 medical topics in language accessible to adult laypersons. Presented in a single alphabetical sequence, articles range in length from one or two paragraphs for minor topics, to several pages or more for major topics. Disease/disorder articles typically cover definition; description; causes and symptoms; diagnosis; treatments; prevention; and more. Test/treatment articles typically cover definition; purposes; precautions; preparation; risks; normal and abnormal results; and much more. This second edition includes more than 200 new entries, 300 updated entries, approximately 650 color... | |
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Necrotizing Enterocolitis (Clinics in Perinatology, Volume 21, Number 2, June 1994) by Barbara J. Stoll MD (Editor), Robert M. Kliegman MD (Editor) June 1994 issue | |
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Necrotizing Enterocolitis (Medical Intelligence Unit) by Brian F. Gilchrist (Editor) The literature on NEC (necrotizing Enterocolitis), especially in the major textbooks, merely recapitulated what had been written in the past; there has been no new guidance. NEC was viewed as a fait accompli; a sometimes-dire disease that was to be confronted only after it reared its perfidious head. This monograph asks the reader to rethink their approach the NEC. Although, there are no compel others to pursue a way to intervene before the die has been cast. Thus, this book is a promissory note and a challenge. |
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The carotid-vertebral space: an 'extended' lateral window to the ventromedial cranial base and lower craniocervical junction.: An article from: Ear, Nose and Throat Journal by Amin B. Kassam (Author), Atul Patel (Author), William Welch (Author), Jeffrey Balzer (Author), Carl Snyderman (Author), Barry Hirsch (Author), Ricardo Carrau (Author) This digital document is an article from Ear, Nose and Throat Journal, published by Thomson Gale on May 1, 2005. The length of the article is 2007 words. The page length shown above is based on a typical 300-word page. The article is delivered in HTML format and is available in your Amazon.com Digital Locker immediately after purchase. You can view it with any web browser. Citation Details Title: The carotid-vertebral space: an 'extended' lateral window to the ventromedial cranial base and lower craniocervical junction. Author: Amin B. Kassam Publication: Ear, Nose and Throat Journal (Magazine/Journal) Date: May 1, 2005 Publisher: Thomson Gale Volume: 84 Issue: 5 Page: 312(4) Distributed by Thomson... |
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