Acid-suppressive therapy among infants and risk of anemia at 12 months of age

Ahmad Abu-Sulb; Rawan Al-Najjar; Rama Maghnam; Ashraf Ashhab

doi:10.1177/20503121221123117

Acid-suppressive therapy among infants and risk of anemia at 12 months of age

SAGE Open Med. 2022 Sep 8:10:20503121221123117. doi: 10.1177/20503121221123117. eCollection 2022.

Authors

Ahmad Abu-Sulb¹, Rawan Al-Najjar², Rama Maghnam³, Ashraf Ashhab⁴

Affiliations

¹ Division of Pediatrics, Legacy Community Health, Houston, TX, USA.
² Division of Neonatology, Baylor College of Medicine, Houston, TX, USA.
³ Department of Pediatrics, Monmouth Medical Center, Long Branch, NJ, USA.
⁴ Division of Digestive & Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Abstract

Objectives: Numerous studies have shown that links exist between exposure to acid suppression among adults and nutritional deficiencies, especially vitamin B12 and iron. While the use of acid suppression among children and infants is common, nutritional deficiency remains a concern but does not have numerous studies to support it. We conducted a cohort study to examine this concern; the hypothesis we proposed is that acid-suppressive therapy (AST) during infancy is linked to anemia in the first year of life.

Methods: This retrospective cohort study included infants born between 2017 and 2018 who visited Legacy Community Health. The inclusion criteria were exposure to acid suppression for a minimum of 1 month and a hemoglobin reading at 12-15 months. Infants who had hemoglobinopathies, failure to thrive, or malabsorption syndromes were excluded. Mean hemoglobin was calculated, and student's t-test was applied to find statistical differences between the two groups. Change in weight before and after treatment was recorded. Occurrence of respiratory and gastroenterological adverse events was recorded in the exposed group.

Results: Overall, 135 exposed infants were identified 135 controls were selected. The majority of the sample included Hispanic girls. Ranitidine was the most commonly prescribed medicine. The duration of treatment was 3 months. Weight improved significantly at termination of the treatment. There was no significant difference between the hemoglobin level of cases and controls, and both were not considered anemic.

Conclusion: AST was not linked to anemia, despite the slightly lower hemoglobin in some cases. There were few weaknesses in our study; therefore, further studies can examine this link by focusing further on medication type and close follow-up. We found that although proton pump inhibitors are considered the first line of treatment, histamine-2 receptor antagonists were more frequently prescribed. Strategies to familiarize general pediatricians with the NSAPGHAN guidelines might be needed.

Keywords: Acid suppression; anemia; gastroenterology/hepatology; infant.