This birth cohort study (ARIES, Santiago, Chile) followed 200 infants from birth to 24 months to assess whether early PPI exposure (first 6 months) or any PPI exposure (first 24 months) was associated with respiratory tract infections (RTIs), hospitalizations, and antibiotic use.
Early PPI use (8% of infants) was independently linked to otitis media (aOR 9.5), viral croup (aOR 4.8), RTI-related hospitalization (aOR 19.3), and antibiotic use (aOR 9.9). No significant association was found with lower RTIs (bronchiolitis, pneumonia).
- Small sample (n=200) with only 16 early PPI-exposed infants, producing very wide CIs (e.g., hospitalization aOR 19.3, 95% CI 1.6–225.8). - Single-center cohort in Chile limits generalizability. - Observational design cannot exclude confounding by indication (PPIs prescribed for sicker infants).
Avoid routine PPI prescribing in infants with functional GI complaints (colic, reflux) given the lack of proven benefit and this signal of meaningfully increased upper RTI risk. Reserve PPIs for infants with clear evidence-based indications and reassess promptly.
