Purpose: To compare deprescribing rates of stress ulcer prophylaxis (SUP) between children receiving "usual-dose" (<4 mg/kg/day methylprednisolone equivalents) versus "high-dose" (≥4 mg/kg/day methylprednisolone equivalents) corticosteroids for status asthmaticus in the pediatric intensive care unit (PICU). Methods: This retrospective, cohort study included children <18 years of age receiving corticosteroids for status asthmaticus and SUP from 1/1/2017 to 6/31/2022. The primary objective was to compare the number of children that were deprescribed SUP following transition from the PICU to the floor and at hospital discharge between groups. Secondary objectives included a comparison of SUP-associated adverse events (ADEs) (pneumonia, Clostridium difficile colitis, thrombocytopenia, necrotizing enterocolitis) between groups. Comparisons were performed using exact χ2 test or Wilcoxon U-tests as appropriate, with a P value <.05. Results: Ninety-six patients received usual-dose and 57 received high-dose corticosteroids. Eighteen (11.8%) patients were transferred within 24 hours of PICU admission and started on SUP on the floor. Thirteen (8.5%) patients were discharged home from the PICU. The remaining 122 (79.7%) patients were transferred from PICU to the floor and there was no statistical difference for continuation of SUP on the floor between usual-dose versus high-dose group, 58 (76.3%) versus 31 (67.4%) patients, P = .282. Overall, 25 of 153 (16.3%) patients were discharged home on SUP, but there was no difference between groups. SUP-associated ADEs did not differ between groups. Conclusions: SUP continuation during transitions of care in this cohort was common. Assessment of SUP continuation is needed during transitions of care to promote SUP stewardship and limit risk of SUP-associated ADEs.

The primary aim of this study was to determine continuation rates of stress ulcer prophylaxis (SUP) upon transfer from a pediatric intensive care unit (PICU) to a general medicine unit and upon hospital discharge. The secondary aim was to identify patient characteristics or concomitant medications that were associated with continuation of SUP at transfer from the PICU.

This retrospective chart review included patients who were initiated on acid suppression for SUP in the PICU between June 2021 and May 2022 and subsequently transferred to a general medicine unit prior to discharge. Patients were excluded if they were receiving acid suppressant therapy prior to admission or were started on acid suppressants for an indication other than SUP.

Two hundred three patients (median age, 3.3 years) were included. The rates of SUP continuation at the time of transfer from the PICU to a general medicine unit and at hospital discharge were 61.6% and 9.9%, respectively. Patients continued on SUP at the time of transfer from the PICU were more likely to be prescribed concomitant corticosteroids (p < 0.01), anticoagulants or antiplatelet medications (p < 0.01).

The continuation of SUP from the PICU to the general medicine unit is common at our institution and calls into question the appropriateness of this practice. Future research is warranted to investigate the appropriateness of the continuation of SUP at transitions of care. Additionally, implementation of institutional protocols standardizing review of SUP may help reduce unnecessary prescribing of acid suppressants in general medicine units and at discharge.

The etiology of upper gastrointestinal bleeding (UGIB) varies by age, from newborns to adolescents, with some of the causes overlapping between age groups. While particular causes such as vitamin K deficiency and cow's milk protein allergy are limited to specific age groups, occurring only in neonates and infants, others such as erosive esophagitis and gastritis may be identified at all ages. Furthermore, the incidence of UGIB is variable throughout the world and in different hospital settings. In North America and Europe, most UGIBs are non-variceal, associated with erosive esophagitis, gastritis, and gastric and duodenal ulcers. In recent years, the most common causes in some Middle Eastern and Far Eastern countries are becoming similar to those in Western countries. However, variceal bleeding still predominates in certain parts of the world, especially in South Asia. The most severe hemorrhage arises from variceal bleeding, peptic ulceration, and disseminated intravascular coagulation. Hematemesis is a credible indicator of a UGI source of bleeding in the majority of patients. Being familiar with the most likely UGIB causes in specific ages and geographic areas is especially important for adequate orientation in clinical settings, the use of proper diagnostic tests, and rapid initiation of the therapy. The fundamental approach to the management of UGIB includes an immediate assessment of severity, detecting possible causes, and providing hemodynamic stability, followed by early endoscopy. Unusual UGIB causes must always be considered when establishing a diagnosis in the pediatric population because some of them are unique to children. Endoscopic techniques are of significant diagnostic value, and combined with medicaments, may be used for the management of acute bleeding. Finally, surgical treatment is reserved for the most severe bleeding.

Proton pump inhibitors (PPIs) are widely prescribed and are indicated for the treatment of several gastrointestinal disorders. Allergists may prescribe PPIs as a result of the coincidence of gastroesophageal reflux disease with asthma or rhinitis, or when gastroesophageal reflux disease presents as chronic cough. Furthermore, long-term, high-dose PPI therapy is a recommended option for managing eosinophilic esophagitis, resulting in histologic remission in approximately 40% of patients. Here, we discuss current recommendations for PPI use, its deescalation, and its side effect profile. We review evidence supporting the epidemiologic link between the use of acid-suppressant medication and the subsequent development of allergic disorders.