Association of Proton Pump Inhibitors With Hospitalization Risk in Children With Oropharyngeal Dysphagia
Association of Proton Pump Inhibitors With Hospitalization Risk in Children With Oropharyngeal Dysphagia
复制标题
DOI：
10.1001/jamaoto.2018.1919
复制
发表时间：
2018-12-01
影响因子：
7.8
通讯作者：
Rosen, Rachel L.
中科院分区：
文献类型：
--
作者：
Duncan, Daniel R.;Mitchell, Paul D.;Rosen, Rachel L.
质子泵抑制剂（PPI）通常用于患有口咽吞咽困难和由此导致的误吸的儿童，基于假设这些患者患反流相关肺部疾病的风险更大。很少有数据支持这种方法，并且PPI治疗儿童感染增加的潜在风险可能超过任何潜在的益处。目的：本研究的目的是确定口咽吞咽困难患儿住院风险与PPI治疗之间是否存在关联。设计、环境和参与者我们进行了一项回顾性队列研究，比较2015年1月1日至2015年12月31日期间在吞咽检查中出现异常结果的儿童的住院频率和住院时间。以及接受或未接受PPI治疗的患者，随访至2016年12月31日。我们回顾了在波士顿儿童医院（三级转诊中心）就诊的儿童的记录。参与者包括293名2岁及以下的儿童，在透视吞咽研究中有吸入或渗透的证据。暴露组根据他们接受PPI治疗的暴露程度进行比较。主要结局和测量主要结局是住院率和住院夜数，并以事发率来衡量。在调整合并症后，进行多变量分析以确定住院风险的预测因子。建立Kaplan-Meier曲线来确定PPI处方与首次住院时间的关系。结果共纳入293例患者，平均（SD）年龄8.8（0.4）个月，平均（SD）随访时间18.15（0.20）个月。即使在调整合并症后，接受PPI治疗的患者入院率（发病率比[IRR]， 1.77; 95% CI, 1.16-2.68）和入院夜数（IRR, 2.51; 95% CI, 1.36-4.62）也更高。服用ppi的肠内插管患者入院的风险最高（风险比[HR]， 2.31; 95% Cl, 1.24-4.31）。结论与意义：与未接受PPI治疗的患儿相比，接受PPI治疗的患儿住院风险增加。这些结果支持了对儿童使用PPI风险的日益关注。
IMPORTANCE Proton pump inhibitors (PPI) are commonly prescribed to children with oropharyngeal dysphagia and resultant aspiration based on the assumption that these patients are at greater risk for reflux-related lung disease. There is little data to support this approach and the potential risk for increased infections in children treated with PPI may outweigh any potential benefit.OBJECTIVE The aim of this study was to determine if there is an association between hospitalization risk in pediatric patients with oropharyngeal dysphagia and treatment with PPI.DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective cohort study to compare the frequency and length of hospitalizations for children who had abnormal results on videofluoroscopic swallow studies that were performed between January 1, 2015, and December 31, 2015. and who were or were not treated with PPI, with follow-up through December 31, 2016. Records were reviewed for children who presented for care at Boston Children's Hospital, a tertiary referral center. Participants included 293 children 2 years and younger with evidence of aspiration or penetration on videofluoroscopic swallow study.EXPOSURES Groups were compared based on their exposure to PPI treatment.MAIN OUTCOMES AND MEASURES The primary outcomes were hospital admission rate and hospital admission nights and these were measured as incident rates. Multivariable analyses were performed to determine predictors of hospitalization risk after adjusting for comorbidities. Kaplan-Meier curves were created to determine the association of PPI prescribing with time until first hospitalization.RESULTS A total of 293 patients with a mean (SD) age of 8.8 (0.4) months and a mean (SD) follow-up time of 18.15 (0.20) months were included in the analysis. Patients treated with PPI had higher admission rates (Incidence rate ratio [IRR], 1,77; 95% CI, 1.16-2.68) and admission nights (IRR, 2.51; 95% CI, 1.36-4.62) even after adjustment for comorbidities. Patients with enteral tubes who were prescribed PPIs were at the highest risk for admission (hazard ratio [HR], 2.31; 95% Cl, 1.24-4.31).CONCLUSIONS AND RELEVANCE Children with aspiration who are treated with PPI have increased risk of hospitalization compared with untreated patients. These results support growing concern about the risks of PPI use in children.