CHEARS

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The pharmacology of pediatric patients are different from the adults. Accordingly, the treatment modality also changes. So there are certain recommendations for pediatric patients when GI prophylaxis is initiated.

Stress ulcer prophylaxis is given when at-least two of the risk factors exist. They are:

□ Mechanical ventilation > 48 hours

□ Organ failure

Following are the key indications of organ failure in pediatric patients:

□ Respiratory failure (peak inspiratory pressure > 25 cm H2O).

□ Renal failure (serum creatinine ≥2 times the upper limit of normal for age, or two-fold

increase in baseline serum creatinine)

□ Neurologic failure (Glasgow coma score ≤11, or acute mental status change with a

decrease in Glasgow coma score ≥3 from baseline)

□ Hepatic failure (total bilirubin ≥4 mg/dL or serum alanine transaminase ≥2 times the

upper limit of normal for age)

□ Coagulopathy (platelet count <100,000/μL or PT, aPTT, or thrombin time >20% of control

value)

□ Pediatric Risk of Mortality Score≥102

□ Shock (hypotensive for age and poor peripheral perfusion or acidosis)

□ Surgery time ≥3 hours

□ Multi-trauma (trauma to at least two systems)

□ Pneumonia

□ SUP is recommended in patients with thermal injury (≥20% total body surface area)

INAPPROPRIATE INDICATIONS:

□ Continuation of SUP when no risk factors exist. 

□ Initiation of SUP along with short term high dose corticosteroid therapy for acute respiratory disease ( No additional risk factors).

PEDIATRIC DOSING:

□ PANTOPRAZOLE: 

Parenteral dose ( Do not exceed adult dose): 1mg/Kg IV OD

Enteral dose ( Do not exceed adult dose): 1mg/Kg PO/ NG OD

□ FAMOTIDINE:

Parenteral dose: 0.25mg/kg/dose IV q12h.

Enteral dose: 0.5mg/Kg/dose PO/NG BD

SUCRALFATE IS NOT RECOMMENDED FOR PEDIATRIC PATIENTS 

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