From the Research
Proton pump inhibitors (PPIs) are commonly used post tracheoesophageal fistula (TEF) repair in neonates to reduce gastric acid production and prevent complications such as esophagitis or recurrent strictures. The standard practice typically includes medications such as omeprazole or lansoprazole given once daily, with the duration depending on the individual patient's recovery and symptoms 1. PPIs help protect the healing esophageal tissue and reduce the risk of complications, and many infants with TEF have associated gastroesophageal reflux disease (GERD), making acid suppression particularly important. Some studies have shown that PPIs may not provide significant symptom improvement in infants with GERD, but they are still widely used in clinical practice due to their effectiveness in reducing acid production and preventing complications 2. The medication is typically administered intravenously immediately post-surgery and then transitioned to oral formulations once enteral feeding is established. Regular follow-up with monitoring for symptoms of reflux and potential PPI side effects is essential during the treatment course. Key considerations include:
- The use of PPIs in neonates is not without controversy, with some studies raising questions about their effectiveness and safety in this population 3.
- The most recent and highest quality study on this topic, a 2023 Cochrane review, found that there is very low-certainty evidence about the effectiveness of PPIs in infants with GERD, and that further studies are needed to determine their role in this population 1.
- Despite these uncertainties, PPIs remain a common and important part of the treatment regimen for neonates post TEF repair, and their use should be guided by careful consideration of the individual patient's needs and circumstances. In terms of specific medications and dosages, omeprazole and lansoprazole are commonly used, with dosages ranging from 0.5-1.5 mg/kg/day for omeprazole and 0.5-1 mg/kg/day for lansoprazole 4, 5. However, the optimal dosage and duration of treatment have not been well established, and further research is needed to determine the most effective and safe treatment regimens for neonates post TEF repair. Overall, while there are uncertainties and controversies surrounding the use of PPIs in neonates, they remain an important part of the treatment regimen for many patients, and their use should be guided by careful consideration of the individual patient's needs and circumstances.