Efficacy And Safety Evaluation Of Stress Ulcer Prophylaxis In Critically Ill Children

Objective:To evaluate the effectiveness and safety of a stress ulcer prophylaxis strategy for critically ill children receiving enteral nutrition.Methods:A retrospective cohort study was used to extract clinical information from the Paediatric Intensive Care Database（PIC）on children who received enteral nutrition.Children were grouped according to whether they received a proton pump inhibitor（PPI）or Histamine-2 Receptor Antagonist（H₂RA）or a combination/sequential therapy of the two drugs within 2 days of admission to the intensive care unit（ICU）,with those receiving stress prophylaxis as the SUP group and those not receiving as the control group.Baseline characteristics between the two groups were balanced using 1:3 propensity score matching（PSM）.Differences in clinical outcome indicators such as in-hospital mortality,incidence of gastrointestinal bleeding,length of ICU stay,incidence of hospital-acquired pneumonia and incidence of bloodstream infections were compared between children in the SUP group and those in the control group.Results:According to the inclusion and exclusion criteria,2970 children were finally enrolled for analysis,including 827 in the SUP group and 2143 in the control group.After performing a 1:3 PSM,448 children were enrolled in the SUP group and 1285in the control group.Baseline characteristics:Before the propensity score matching,the differences in age and PCIS score between the two groups were not significant（P>0.05）,while there were significant differences in gender,type of ICU admission,and major disease type of ICU admission（P<0.05）;After propensity score matching,there was no statistical difference between the two groups in terms of gender,age,type of ICU admission,type of main disease of ICU admission and PCIS score（P>0.05）.Risk factors for gastrointestinal bleeding:before propensity matching,the proportion of the SUP group treated with anticoagulants or antiplatelet agents and glucocorticoids was higher than that of the control group（P<0.05）,while the proportion of coagulation dysfunction and surgery beyond 4hours was lower than that of the control group（P>0.05）;after propensity score matching,the risk factors for stress ulcer bleeding were evenly distributed in the two groups.There was no statistically significant difference in the rate of death,incidence of gastrointestinal bleeding,incidence of hospital-acquired pneumonia and length of hospital stay between the two groups after propensity score matching（P>0.05）,and the incidence of bloodstream infection was lower in the SUP group than in the control group,and there was a statistically significant difference（P<0.05）.Conclusion:In children receiving enteral nutrition,the use of stress ulcer prophylaxis does not reduce the incidence of in-hospital mortality and gastrointestinal bleeding.