| Evaluation of gastric pH and guaiac measurements in neonates receiving acid suppression therapy during extracorporeal membrane oxygenation. | |
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MedLine Citation:
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PMID: 15460173 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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STUDY OBJECTIVES: To assess gastric pH measurements, evaluate the frequency of guaiac-positive gastric aspirates, and characterize the appearance of gastric aspirates in neonates receiving acid suppression therapy during extracorporeal membrane oxygenation (ECMO). DESIGN: Retrospective, observational study. SETTING: Intensive care unit in a 225-bed tertiary care pediatric referral hospital. SUBJECTS: Thirteen neonates receiving ECMO. MEASUREMENTS AND MAIN RESULTS: Gastric pH measurements, guaiac test results, appearance of gastric aspirates, and ranitidine and antacid dosing were recorded. On ECMO day 1, mean+/-SD gastric pH was 4.3+/-2.8 in the five neonates whose pH was documented. Intravenous ranitidine 2.9+/-0.4 mg/kg/day was started in all neonates by ECMO day 2. Gastric pH was less than 4.0 in seven neonates; these low pH values accounted for only 10% of gastric pH measurements. The frequency of positive guaiac results in neonates with pH measurements below 4.0 was 27% compared with 41% for neonates with a gastric pH of 4.0 or greater (p=0.125). Guaiac tests were positive in 69 (42%) aspirates in 11 neonates. Of the guaiac-positive aspirates that had a corresponding pH measurement, 94% had a pH of 4.0 or greater. Guaiac-positive aspirates had evidence of bile (49%), antacid (17%), and blood (7%) in gastric fluid. In six patients, ranitidine dosages were increased to 3.9+/-0.6 mg/kg/day due to low pH and/or positive guaiac results. In two of these neonates, gastric pH remained below 4.0 in nine of 35 pH measurements despite increased ranitidine dosing. Guaiac results remained positive in all subsequent aspirates in five out of six of these neonates. No neonates developed clinically significant upper gastrointestinal bleeding (UGIB). CONCLUSIONS: Gastric pH is variable in neonates receiving histamine2-receptor antagonist and antacid therapy during ECMO, and gastric pH of 4.0 or greater does not decrease the frequency of guaiac-positive aspirates. Higher gastric pH measurements are confounded by duodenogastric reflux and the presence of blood and/or antacid in gastric fluid. Motility agents in combination with acid suppression therapy for prevention of UGIB may be necessary in this setting based on gastric pH measurements, appearance of gastric aspirates, and guaiac testing. |
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Authors:
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Catherine M Crill; Mark C Bugnitz; Emily B Hak |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Pharmacotherapy Volume: 24 ISSN: 0277-0008 ISO Abbreviation: Pharmacotherapy Publication Date: 2004 Sep |
Date Detail:
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Created Date: 2004-10-04 Completed Date: 2004-12-02 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8111305 Medline TA: Pharmacotherapy Country: United States |
Other Details:
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Languages: eng Pagination: 1130-6 Citation Subset: IM |
Affiliation:
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Departments of Pharmacy and Pharmacology, Center for Pediatric Pharmacokinetics and Therapeutics, University of Tennessee Health Science Center, Memphis, TN 38163, USA. ccrill@utmem.edu |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Antacids
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pharmacology* Anti-Ulcer Agents / pharmacology* Extracorporeal Membrane Oxygenation* Female Gastric Acid / secretion* Gastric Mucosa / drug effects* Guaiac / diagnostic use Humans Hydrogen-Ion Concentration Infant, Newborn Intensive Care Units, Neonatal Male Occult Blood* Ranitidine / pharmacology* Retrospective Studies |
| Chemical | |
Reg. No./Substance:
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0/Antacids; 0/Anti-Ulcer Agents; 66357-35-5/Ranitidine; 9000-29-7/Guaiac |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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