Guillet R, Stoll BJ, Cotton CM, et al., for members of the National Institute of Child Health and Human Development Neonatal Research Network. Pediatrics. 2006; 117: e137-e142, 531.

Treatment with histamine-2 receptor (H2) blockers in very low birth weight infants seems to raise the risk of necrotizing enterocolitis (NEC), a finding that is consistent with trial results showing a decreased NEC risk with acidification of infant feeds, according to this study. In combination with previous reports, the new findings suggest that gastric pH plays an important role in the pathogenesis of NEC. The authors point out that H2-receptor blockers are often given to neonates, to treat esophagitis due to reflux, for example, or to minimize gastritis due to steroid therapy. The team's current findings are based on a study of 11,072 infants logged in a national registry between September 1998 and December 2001. The overall NEC rate was 7.1%, the report indicates, and the incidence increased as birth weight fell. The NEC rate was 3.9% among infants weighing 1,251 to 1,500 grams, but 11.5% among those between 401 and 750 grams. Depending on the analysis, antecedent H2-blocker use raised the risk of NEC 49% (p = 0.0010) or 71% (p < 0.0001), the authors note.