OVER/UNDER PRESCRIBING OF ANTI-REFLUX MEDICATION IN INFANTS WITH CARDIAC DIAGNOSES AFFECTING WEIGHT GAIN?.

Brooks, T.; Rhodes, A.

OVER/UNDER PRESCRIBING OF ANTI-REFLUX MEDICATION IN INFANTS WITH CARDIAC DIAGNOSES AFFECTING WEIGHT GAIN?.

All Authors

Brooks, T.

Rhodes, A.

LTHT Author

Brooks, Teresa
Rhodes, Alix

LTHT Department

Medicines Management & Pharmacy Services
Clinical Pharmacy
Leeds Children's Hospital
Children's Services
Paediatric Dietetics

Non Medic

Pharmacist
Children's Dietitian

Publication Date

2025

Item Type

Conference Abstract

Abstract

Aim The aim was to see if there was evidence of over and under prescribing of reflux medication once a child less than 1 year with a cardiac shunt dependent diagnoses has been discharged from hospital despite a close outpatient follow up by clinicians, and whether there was any relationship with patient growth. Gastroesophageal reflux disease (GORD) is common in infants with congenital heart disease (CHD) which is linked with poor growth and aspiration pneumonia in this cohort.1 Symptom management involves optimisation of enteral feeds and provision of pharmaceutical agents to support with gastric emptying and reduction of gastric acidity.2 Proton pump inhibitors (PPI) and prokinetic agents are often used as the first line treatment, but there are concerns they are commonly inappropriately and/or over-prescribed,3 which can be detrimental to patient care due to risks of cardiotoxicity. Method A retrospective review was conducted looking at shunt dependant infants discharged from a regional children's cardiac unit between 2020-2023. Growth, presence of reflux symptoms and anti-reflux medication prescribed were recorded at discharge from hospital and 3-months post-discharge. Medication doses were reviewed against the British National Formulary for Children.4 Results 94 patients included in the discharge data. 23 patients were readmitted into hospital or died before the 3-month point, leaving 71 patients to be included in the 3-month data. At discharge 30% (n=28) had reflux symptoms, 29% (n=8) of these had suboptimal anti-reflux prescriptions. Whilst 70% (n=66) had no reflux symptoms, and only one of these had suboptimal medication. At 3 months 28% (n=20) had reflux symptoms, and 70% (n=14) of these had suboptimal anti-reflux prescriptions. Whilst 72% (n=51) had no reflux symptoms, and 11% (n=6) of these had suboptimal medication. Overall, 24% (n=17) of infants had poor growth across the 3 months, with 35% (n=6) of these having a period reporting reflux symptoms and not on optimised anti-reflux medication. Conclusion Reports of GORD symptoms and poor growth is common in infants with shunt dependant cardiac diagnoses. Treatment of GORD with pharmaceutical agents is high, but there is strong evidence of over-prescribing and under-prescribing, which increased over time post discharge. The lack of optimisation of reflux management could be linked with poor growth. Regular medication review from a specialist pharmacist at the point of discharge from hospital and in the outpatient setting would support both the symptom management of GORD and appropriate provision of potentially cardiac toxic medications.