Bethesda, MD—Acid-suppression therapy is increasingly prescribed to infants to treat suspected gastroesophageal reflux.

A study published in Pediatrics looks at risks of side effects. Researchers from Walter Reed National Military Medical Center and colleagues point out that otherwise healthy infants often receive acid-suppression therapy (AST), including proton-pump inhibitors (PPIs) and histamine H2-receptor antagonists (H2RAs).

The study team also notes PPI use has been associated with increased fracture risk in older adults, although two preliminary studies in children have shown conflicting results when it comes to that risk.

As a result, the researchers performed a retrospective cohort study of children born from 2001 to 2013 who were followed for 2 or more years, excluding those with osteogenesis imperfecta, cholestasis, or child maltreatment.

The study used prescription data to identify AST prescription prior to age 1 year, while International Classification of Diseases, Ninth Revision, Clinical Modification codes identified fractures after age 1 year. Of 851,631 included children, 97,286 (11%) were prescribed AST in the first year of life. Of those, 7,998 (0.9%) were prescribed PPI; 71,578 (8%) were prescribed H2RA; and 17,710 (2%) were prescribed both.

Results indicate that infants prescribed AST had an earlier median first fracture age (3.9 vs. 4.5 years). After adjustment, researchers determined that increased fracture hazard was associated with PPI use (21%) and PPI and H2RA use (30%), but not H2RA use alone.

In addition, the study showed that longer duration of AST treatment, as well as earlier age of first AST use, were both associated with increased fracture hazard.

“Infant PPI use alone and together with H2RAs is associated with an increased childhood fracture hazard, which appears amplified by days of use and earlier initiation of ASTs,” study authors caution. “Use of AST in infants should be weighed carefully against possible fracture.”

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