+ Resolve Article
+ Follow Us
Follow on FacebookFollow on Facebook
Follow on TwitterFollow on Twitter

+ Translate
+ Subscribe to Site Feed
GeoScience Most Shared ContentMost Shared Content

Evaluation of gastric pH and guaiac measurements in neonates receiving acid suppression therapy during extracorporeal membrane oxygenation

, : Evaluation of gastric pH and guaiac measurements in neonates receiving acid suppression therapy during extracorporeal membrane oxygenation. PharmacoTherapy 24(9): 1130-1136

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.


PMID: 15460173

DOI: 10.1592/phco.24.13.1130.38085

Other references

Gleicher, N.; Weghofer, A.; Barad, D., 2008: Preimplantation genetic screening: "established" and ready for prime time?. Unless attempts to improve pregnancy rates and/or diminish miscarriage rates through preimplantation genetic screening (PGS) are applied to only carefully selected patients, they will fail. Because specific PGS indications have remained undefined,...

TRUFFERT.P.; Sebileau, P., 1954: Pierre Sebileau, 1859-1953. Les Annales D'oto-Laryngologie 71(1): 5-11

A.A.basi, M.A.; A.K.raghouli, A.A.; Minasian, A.N., 1992: Photochemically assisted solar desalination of saline water. Bromine and iodine have been utilized in this study as heat generating media for the enhancement of overall efficiency of the simple conventional basin type solar stills. Results of the experimental work showed that the solar still of bromine medi...

Goldstein, L.A.; Robinson, W.G., 1981: Factor-dependent dissociation of wheat germ ribosomes. Ribosome dissociation factor has been found in wheat germ acetone powder extracts. Further purification of the crude extract by pH an ammonium sulfate fractionations, DEAE-cellulose and CM-Sephadex column chromatography has resulted in the separat...

Valkhoff, V.E.; Sturkenboom, M.C.J.M.; Hill, C.; Veldhuyzen van Zanten, S.; Kuipers, E.J., 2015: Low-dose acetylsalicylic acid use and the risk of upper gastrointestinal bleeding: a meta-analysis of randomized clinical trials and observational studies. Low-dose acetylsalicylic acid (LDA, 75 mg/day to 325 mg/day) is recommended for primary and secondary prevention of cardiovascular events, but has been linked to an increased risk of upper gastrointestinal bleeding (UGIB). To analyze the magnitude...

Hernberg, S.; Nurminen, M.; Hasan, J., 1967: Oxygen and glucose consumption and lactate production of erythrocytes of workers exposed to inorganic lead. Internationales Archiv für Arbeitsmedizin 23(2): 117-126

Swenson, J.E., 1983: Computers in nursing practice: computerized staff development records. Computers in Nursing 1(4): 6-6

Souverain, M., 1953: Regulation concerning soaps. Le Medecin D'usine; Revue D'hygiene Industrielle et des Maladies Professionnelles 15(7): 374-375

Lazikova, G.F.; Vardanian, N.V.; Nikolaevskiĭ, G.P., 1979: Age distribution of the incidence and immune structure of the pediatric population in epidemic parotitis. An increase in the incidence of epidemic mumps among children is observed at 1 year, the highest incidence is found in the age group of 3--4 years which clearly correlates with the immunological status of the examined children. Antihemagglutinins...

Jarnvig, I.L.; Naesh, O.; Hindberg, I.; Behnke, O.; Bregengaad, C.; Wilhjelm, B., 1990: Platelet responses to intravenous infusion of Intralipid in healthy volunteers. Platelet function and morphology were studied in eight healthy male volunteers before, immediately after, and 1 d after the infusion of 250 mL of 10% Intralipid. The plasma concentrations of the platelet-release products .beta.-thromboglobulin (.b...