Newborn upper GI bleeds: Cochrane conclusions on prevention and treatment

  • Green DS & al.
  • Cochrane Database Syst Rev
  • 2 Jul 2019

  • International Clinical Digest
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Takeaway

  • Histamine-2 receptor antagonists (H2RAs) reduce risk for gastrointestinal (GI) bleeding in high-risk newborns, but evidence that H2RAs and proton pump inhibitors (PPIs) decrease duration or continuation of existing bleeding is very low quality.

Why this matters

  • Findings suggest the need for caution in using H2RAs or PPIs in this population.

Key results

  • With H2RAs (4 trials), upper GI bleeding risk was reduced in high-risk infants: 
    • Typical risk ratio, 0.36 (95% CI, 0.22-0.58),
    • Typical risk difference: −0.20 (95% CI, −0.28 to −0.11),
    • Number needed to treat for beneficial outcome: 5 (95% CI, 4-9), and
    • Moderate quality of evidence.
  • In 1 small trial (n=53) of H2RAs vs no intervention, no mortality effect was identified, with very low-quality evidence.
  • In infants with existing bleeding, H2RAs or PPIs reduced duration or continuation, but evidence quality was very low and low, respectively.
  • 1 small trial found no difference in need for transfusion with H2RAs vs no treatment.
  • Major morbidities, duration of hospital stay, long-term outcomes were not reported.
  • No trial had a low bias risk.

Study design

  • Cochrane review of 11 randomized trials (818 infants).
  • Funding: Vermont Oxford Network, USA; National Institute for Health Research, UK.

Limitations

  • Mostly low, very low quality of evidence.