We have been discussing this on our ward. Should we provide therapy to prevent SRMD ( stress-related mucosal disease) in our neonates that are ventilated, do not get any feeds or are otherwise severly ill?

And what therapy do you believe is best?

If you know any current evidence please share it!

As you know H2-blockers have gone out of fashion in NICU settings (I think those are widely used in adult ICUs).

I found this paper through Pubmed 

http://www.ncbi.nlm.nih.gov/pubmed/17245096

Hope you get some input there. Would be great to hear where your discussions end up!

Thats what I had remembered as well - thanks for the link!

I did not find anything related to newborns and stress-related mucosal disease. There is weak evidence for PPI to prevent gastric bleeding in pediatric patients http://www.ncbi.nlm.nih.gov/pubmed/19770788

PPI at least seem to be effective in achieving higher gastric pH levels in neonates http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616221/ and http://www.ncbi.nlm.nih.gov/pubmed/17204951/ although best dosing advice seems elusive.

 

And this paper on acid suppression and side-effects in neonates warrants some cautions regarding H2-blockers (although one should generally not extrapolate too much)

http://pediatrics.aappublications.org/content/129/1/e40.full