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Medical treatment of gastroesophageal reflux in the neonatal intensive care unit: current practice

Journal of Perinatology volume 45, pages 616–621 (2025)Cite this article

Subjects

Abstract

Objective

To determine current prescribing practice of acid-suppressive therapy in preterm infants admitted to the neonatal intensive care unit (NICU).

Study design

Cohort study of infants 22 to 27 weeks gestation discharged from Pediatrix Medical Group NICUs between 2015 and 2020.

Results

Of 13,735 infants meeting inclusion criteria, 11% were exposed to acid-suppressive therapy during hospitalization, with 3% of those treated on the day of discharge. Exposed infants had lower birthweights (BW) (p < 0.001). 42% of infants exposed to acid-suppressive therapy received a gastroesophageal reflux disease (GERD) diagnosis (p < 0.001). Median (25th–75th percentile) duration of use was 7 (4–14) days. Use decreased overall during the 5-year period (p < 0.001).

Conclusion

Acid-suppressive therapies are used commonly in preterm infants and receipt is higher in infants with lower BWs. Use has significantly decreased over time and appears to be targeted, with many infants treated for one-week courses and without a diagnosis of GERD.

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Data availability

The data that support the findings of this study are available from Pediatrix BabySteps Clinical Data Warehouse, but restrictions apply to the availability of these data, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the Pediatrix Medical Group.

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Acknowledgements

This research was completed with the support of the Duke Department of Pediatrics, the Duke Pediatric Research Scholars Program, and the Duke Clinical Research Institute.

Funding

This work was funded by the Duke Clinical Research Institute’s R25 Summer Training in Academic Research (STAR) Program (grant #5R25HD076475-10). This work was also funded in part by (U24TR001608) of the NCATS Trial Innovation Network. This work was also funded under the National Institute of Child Health and Human Development (NICHD) contract (HHSN275201000003I) for the Pediatric Trials Network (PI Danny Benjamin). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Dr Foote is supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development under award 1T32HD104576.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Duke University, Durham, NC, USA

    Chelsea Lockyear, Ashley Stark, Henry P. Foote, Sharla Rent, William Malcolm, Rachel G. Greenberg & Samia Aleem

  2. Duke Clinical Research Institute, Durham, NC, USA

    Anthony Agyeman, Manar Bouleqcha, Noam Cohen, Clare Matusevich, Ansley Pantsari, Shuyan Wang & Rachel G. Greenberg

  3. Pediatrix Center for Research, Education, Quality, and Safety, Sunrise, FL, USA

    Veeral N. Tolia

Authors
  1. Chelsea Lockyear
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Contributions

All authors were involved in the study design, analysis, and manuscript revision. All authors read and approved the final manuscript. CO Lockyear: Dr. Lockyear contributed to the conception and design of the study, the data interpretation, the manuscript drafting, and the critical revision of the manuscript. AC Stark: Dr. Stark contributed to the data analysis and interpretation of the study and the critical revision of the manuscript. HP Foote: Dr. Foote contributed to the conception and design of the study and the critical revision of the manuscript. A Agyeman: Mr. Agyeman contributed to the conception and design of the study and the critical revision of the manuscript. M Bouleqcha: Ms. Bouleqcha contributed to the conception and design of the study and the critical revision of the manuscript. N Cohen: Mr. Cohen contributed to the conception and design of the study and the critical revision of the manuscript. C Matusevich: Ms. Matusevich contributed to the conception and design of the study and the critical revision of the manuscript. A Pantsari: Ms. Pantsari contributed to the conception and design of the study and the critical revision of the manuscript. S Wang: Ms. Wang contributed to the conception and design of the study and the critical revision of the manuscript. SM Rent: Dr. Rent contributed to the conception and design of the study and the critical revision of the manuscript. WF Malcolm: Dr. Malcolm contributed to the conception and design of the study, the data interpretation, and the critical revision of the manuscript. RG Greenberg: Dr. Greenberg contributed to the conception and design of the study, the data analysis and interpretation, and the critical revision of the manuscript. VN Tolia: Dr. Tolia contributed to the data acquisition, the data interpretation, and the critical revision of the manuscript. S Aleem: Dr. Aleem had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Aleem contributed to the conception and design of the study, the data analysis, the data interpretation, and the critical revision of the manuscript. High school student, college student, medical student, or teacher affiliated with the Duke Clinical Research Institute’s R25 Summer Training in Academic Research (STAR) Program: Anthony Agyeman, Manar Bouleqcha, Noam Cohen, Clare Matusevich, Ansley Pantsari, Shuyan Wang.

Corresponding author

Correspondence to Samia Aleem.

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Competing interests

The authors declare no competing interests.

Ethics approval

This study was approved as exempt research by the Duke University Institutional Review Board under a waiver of consent. This study was performed in accordance with the Declaration of Helsinki.

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Lockyear, C., Stark, A., Foote, H.P. et al. Medical treatment of gastroesophageal reflux in the neonatal intensive care unit: current practice. J Perinatol 45, 616–621 (2025). https://doi.org/10.1038/s41372-025-02238-9

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