P2C271: Reduction in Acid Suppression Therapy in Neonates – a Single Center Experience

Background: Acid suppression therapy (AST) is often prescribed at discharge from the NICU with no end point. This is concerning for newborns receiving AST, in the form of histamine-2 receptor antagonists (H2RA) and proton pump inhibitors (PPI), for treatment of gastroesophageal reflux (GER) as evidence shows little symptomatic improvement and increased risk for adverse effects. AST is commonly used in the NICU and the duration of therapy in the outpatient setting has not been studied. We undertook a project to establish evidence-based criteria for H2RA/PPI prescriptions in the NICU based on guidelines from the AAP. The primary goal of this project is to evaluate the continuing use of AST after discharge and changes in AST usage while admitted to the NICU.

Methods: Interventions included educational events regarding indicated uses for AST and management of GER in newborns and a guideline recommending a limited seven-day trial period for AST with implementation of a stop date while in the NICU. We then collected data on AST prescriptions in the NICU pre (November 2018-September 2020) and post intervention (November 2020-September 2022). We obtained AST data on newborns who had the prescription continued at discharge. The primary outcomes of the study include continuation of medication at discharge and outpatient prescription of AST. Secondary outcomes include total number of AST prescriptions, number of nonindicated AST prescriptions, and duration of use. Binominal data was analyzed using chi-square test. P-value of < 0.05 was considered significant.

Results: 52% of newborns in the pre-intervention group were prescribed AST at discharge compared to 37% in the post-intervention group (P=.18). Outpatient data was available for 21 (55%) of these newborns and showed that 24% were on AST for 1 – 3 months post discharge, 9% for 4-6 months, 29% for 7-11 months, and 38% for >12 months. 14 (67% - eight pre-intervention and six post-intervention) had AST discontinued at the time of analysis with an average time to stop of 229 days. Changes in overall AST usage, non-indicated usage of AST, and duration of AST use are summarized in Table 1.

Conclusion: A statistically significant decrease in non-indicated usage for AST and duration of AST use was observed, both of which represent positive changes related to the intervention. Outpatient data suggests that newborns discharged from the NICU on AST continue on the medication for an extended period of time. This suggests that the reduction in AST being continued at discharge, although not statistically significant, is clinically important as it likely led to reduced AST exposure in the outpatient setting. The results of this study emphasize the importance of both inpatient and outpatient education to reduce the overall burden of exposure to PPI/H2RA and demonstrate feasible interventions that could be implemented at other institutions.