Stress Ulcer Prophylaxis Safe for Pediatrics With Critical Asthma

Alexa R. Roberts, MD

Pediatric patients hospitalized for critical asthma can receive stress ulcer prophylaxis without much risk of negative gastrointestinal adverse events.

A team, led by Alexa R. Roberts, MD, Resident Physician Johns Hopkins All Children's Hospital, estimated the rate and identified the trends of stress ulcer prophylaxis prescription patterns in a large, multicenter registry, while exploring the differences in gastrointestinal bleeding, gastritis, and stress ulcer prophylaxis-related adverse events.

The data was presented during the American Academy of Pediatrics (AAP) 2021 Virtual Conference.

The Study

The perception that systemic corticosteroids impair epithelial cytoprotective mechanisms, while increasing the risk of gastrointestinal bleeding had led to the children hospitalized for critical asthma to receive stress ulcer prophylaxis with histamine-2-antogonists or proton pump inhibitors.

In the retrospective, multicenter cohort, the investigators examined data from the Pediatric Hospital Information System registry from 42 pediatric hospitals between 2010-2019 of 30,177 patients between 3-17 years admitted to the pediatric intensive care unit for critical asthma receiving corticosteroids.

Of the patients included in the study, 34.4% (n = 10,387) received stress ulcer prophylaxis.

The investigators sought primary outcomes of chronologic and regional variation in stress ulcer prophylaxis prescribing, which was assessed using Joinpoint regression and Pearson’s correlation.

The team identified and compared rates of a number of data points, including gastrointestinal bleeding, gastritis, and enteric ulceration including surrogate markers such as billing data for packed red blood cell transfusion, octreotide infusion, and sucralfate.

They also estimated rates of stress ulcer prophylaxis-related adverse events, which can include C difficile colitis, necrotizing enterocolitis, and thrombocytopenia.

Safety

Overall, there were no episode of gastrointestinal bleeding, transfusion of packed red blood cells, or octreotide infusions record. There was 1 instance of a patient treated with stress ulcer prophylaxis who developed gastric ulceration, while only 0.1% (n = 32) experienced gastritis.

Prescribing rates also varied based on the different hospitals, ranging from 5.5-97.2%. However, there was no correlation to admission volumes.

There was a linear chronologic trend in prescribing patterns observed, with rates increasing from 25.5% in 2010 to 42.1% in 2019. This correlated to a mean increase of 1.9% annually.

There were also no episodes of C difficile colitis or necrotizing enterocolitis observed.

“Although children with CA frequently receive SUP, we observed no episodes of GI bleeding over a 10-year period,” the authors wrote. “Rather than the ubiquitous prescribing of SUP on the basis of corticosteroid exposure alone, we advocate for a targeted approach that instead considers known risk factors for GI bleeding such as coagulopathy, invasive ventilation, or enteric tube placement.”

The study, “Major Gastrointestinal Bleeding and Stress Ulcer Prophylaxis for Pediatric Critical Asthma: A Multicenter, Retrospective Study,” was published online by AAP 2021.