Stress Ulcer Prophylaxis for Critical Asthma

Pediatrics. 2022 Apr 1;149(4):e2021054527. doi: 10.1542/peds.2021-054527.


Background: Children hospitalized for critical asthma (CA) in the pediatric ICU (PICU) are commonly prescribed stress ulcer prophylaxis (SUP) to mitigate risk of gastrointestinal (GI) bleeding. We sought to describe trends for SUP prescribing and explore for differences in rates of GI bleeding, gastritis, and SUP-related complications for those with and without SUP exposure.

Methods: We performed a retrospective, multicenter cohort study using the Pediatric Hospital Information System registry among 42 children's hospitals from 2010 to 2019 including children 3 to 17 years of age admitted to the PICU for CA. Primary outcomes were chronologic and regional variation in SUP prescribing assessed by Joinpoint regression and Pearson's correlation. Rates of GI bleeding, gastritis, enteric ulceration, and SUP-related complications (C. difficile colitis, necrotizing enterocolitis, and thrombocytopenia) were compared for those with and without SUP exposure.

Results: Of 30 177 children studied, 10 387 (34.4%) received SUP. No episodes of GI bleeding were recorded. One subject developed gastric ulceration and 32 (0.1%) gastritis. Linear trends for SUP were observed with rates increasing from 25.5% in 2010 to 42.1% in 2019 (+1.9% annually). Prescribing varied by institution (range: 5.5% to 97.2%) without correlation to admission volumes. Extremely rare rates of SUP-related complications were noted.

Conclusions: Although children hospitalized for CA routinely receive SUP, no episodes of GI bleeding were noted over a 10-year period. SUP solely for corticosteroid exposure may be unwarranted. We advocate for a targeted approach to SUP considering alternative risk factors for GI bleeding.

Publication types

  • Multicenter Study

MeSH terms

  • Asthma* / complications
  • Asthma* / drug therapy
  • Asthma* / epidemiology
  • Child
  • Clostridioides difficile*
  • Cohort Studies
  • Humans
  • Infant, Newborn
  • Intensive Care Units, Pediatric
  • Proton Pump Inhibitors / therapeutic use
  • Retrospective Studies
  • Stomach Ulcer* / chemically induced
  • Stomach Ulcer* / epidemiology
  • Stomach Ulcer* / prevention & control
  • Ulcer / chemically induced
  • Ulcer / drug therapy


  • Proton Pump Inhibitors