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A male premature infant born at 26 weeks of gestation is now at 32 weeks corrected age. He has developed chronic lung disease and is currently on low-flow oxygen. His growth has been faltering, falling below the 10th centile despite 180 mL/kg/day of fortified mother’s own milk. Postprandial regurgitation of milk has been occurring, with suspected gastro-oesophageal reflux. Ultrasound of the abdomen reveals no evidence of pyloric stenosis. Despite a trial of Gaviscon, he continues to regurgitate milk and his growth rate remains inadequate, so a decision is made to commence domperidone. Prior to initiation of therapy, an ECG performed to exclude prolonged QT interval reveals a corrected QTc of 400msec and an electrolyte panel was found to be entirely within normal range. You are asked to consider whether the risk of harm in developing a prolonged QTc and sudden death from a cardiac arrhythmia while receiving domperidone is low enough to warrant the introduction of this medication and whether follow-up ECGs are indicated.
Structured clinical question
In the case of inpatient infants with GORD (population), does domperidone administration (intervention) cause clinically relevant QTc prolongation and/or arrhythmia (outcomes) when compared with baseline (control)?
PubMed, MEDLINE (via EBSCOhost) and Cochrane CENTRAL databases were searched from article inception to 01/09/2019 with the following strategy: ‘((infant) OR (neonate) OR (newborn)) AND (domperidone) AND ((QT) OR (QTc) OR (prolonged) OR (ECG) OR (EKG) OR (arrhythmia))’. In all, 37 abstracts were identified (Medline 21, Embase 16, Cochrane 0) with 21 unique studies, of which five were included (table 1). Of the articles excluded, three were concerned with the use of domperidone as a galactagogue agent in lactating …
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