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Reconciling conflicting evidence on stress ulcer prophylaxis in critically ill children: a systematic review and meta-analysis

Hiroyuki Oikawa, Shotaro Nozaki, Munehiro Furuichi

By appraising all nonrandomized studies using the ROBINS-I V2 (Risk Of Bias In Non-randomized Studies of Interventions, version 2) and finding them at critical risk of confounding, we restricted the synthesis to randomized trials. Stress ulcer prophylaxis (SUP) showed no demonstrated benefit; the previously reported mortality signal was not reproduced, and an exploratory signal of increased central line-associated bloodstream infection could not be excluded. With very low overall certainty, current evidence is insufficient to support routine SUP.

DOI: https://doi.org/10.3345/cep.2026.01823 [Epub ahead of print]

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