Uso de antagonistas do receptor de histamina 2 em neonatos: infecção, enterocolite necrotizante ou morte

Abstract

Background: Histamine-2 receptor antagonists (H2RA) have been commonly prescribed “off label” in neonate hospitalized in neonatal intensive care unit (NICU). Some studies showed that the use of H2RA may predispose to infections, necrotizing enterocolitis (NEC) and mortality in this population. This meta-analysis systematically examined the association between H2RA and infections, NEC and mortality in preterm infants. Methods: A systematic review was made using PubMed, Web of Science and SCOPUS databases up to April 30, 2017. Publications were identified using the search terms “histamine-2 receptor antagonists”, “infection”, “necrotizing enterocolitis”, “mortality” and related terms. Forest plot test was used to graphically present the effect sizes and the 95% confidence interval for the six conditions/terms (infection; pneumonia; sepsis; NEC; urinary tract infection; mortality). Results: Three case–control and three cohort study were included. Meta-analysis showed a significant association between infection and H2RA (RR of 2.13, 95%CI: 1.20 –3.78). Specific analysis found higher incidence of sepsis (RR 2.39; 95%CI: 1.09-5.23; I2 = 91%), pneumonia (RR 2.70; 95%CI: 1.41-5.19; I2 = 0%) and urinary tract infection (RR 8.32; 95%CI: 2.32-29.91; I2 = 91%) in H2RA neonates. Conclusions: Exposure to H2RA is associated with increased risk of infections in preterm infants.