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Title: The Low Down On Bb From Dr. P


Rachael - October 27, 2010 08:18 PM (GMT)
BB is BufferBabies. You can go to BufferBabies.com and read. It is a formulation that makes a stable (this is important because the compounding pharmacy's do not make a stable formula; that is stable beyond 5 days) liquid formulation of PPI (such as Prevacid, omeprazole, prilosec, Nexium) for your baby. Then you can add the dose to the bottle. We have treated more than 3,500 infants now with BufferBabies at the MarciKIDs dose.

BufferBabies (and also the buffer in Zegerid) tricks the acid making cells into coming on. So BufferBabies (or Zegerid) can be given anytime of the day and along with the bottle because it is immediately absorbed. It takes 1 to 2 weeks to work because the acid pumps will not be recruited (which means they won't be stimulated to turn on) by the delayed release PPI. That is why the Buffer in BufferBabies is so important because it "tricks" the little acid pumps to come on and then the PPI (which is immediate release in the BufferBabies) gets right into the bloodstream and turns all those evil little acid pumps off. Unless the little pumps are on they canít be shut off.

Nighttime is the most difficult time, sometimes a slightly larger dose at night is best for the first week.


BB Hell is rare, we looked at 432 patients starting BB and 12% developed gas (BB hell is gas). 88% had no gas effect. Gas drops such as simethicone (Mylicon, or generic) are useful in breaking up gas into small bubbles that can be passed more easily. Buffer Babies will win, but you have to stick with it through the first week. Then, the acid will retreat and the body of your LO gets use to the BufferBabies/PPI. Also, realize that depending on how much damage is present, it may take more time to heal.

Why BB or CC-M with prevacid, prilosec or nexium?

1. immediate release is a really big deal for a lot of these babies b/c dosing on an empty stomach 30 minutes prior to eating is often very, very difficult. Absolute minimum of 2 hours from the end of the last bottle (and that's if BFing or using an elemental formula) and then wait 30 minutes. Needs to be longer if using regular formula - minimum of 3 probably hours.

2. the formulation for the delayed release PPI's is for an adult GI tract so there's no guarantee that the meds will be appropriately released and absorbed properly in a baby's GI system. Also, the immediate release has the buffer (obviously - hence the name) and this tricks the acid secreting cells (parietal cells) into trying to turn on - and this happens just as the PPI part of the BufferBabies is arriving at the parietal cells - And guess what happens. All those acid pumps that got tricked into coming on - all get shut down.

That is why you can give the BB/PPI or CC-M at bedtime and get nighttime acid control and you can't with the delayed release PPIs. Also why the immediate release PPIs act so much quicker (3 to 4 days to get to full effect vs 2 weeks for delayed release PPI).

When to increase BB/Zegerid or CC-M dosing:

There are three times for increasing altering doses.
1. About a week after starting - Add 1 to 1.5mL per dose (this is to countreact the bodies attempt to overcome the PPI). This happens once.
2. Every 3 to 4 pound weight gain add 1mL per dose
3. If teething or a cold then add an extra dose per day for a few days till all is back to normal.


Cost of BB:

Prevacid OTC is approx 55 cents per capsule. The BufferBabies is about 25 cents per day. With BufferBabies, you mix 34 capsules of the Prevacid 15mg into the BB. This will make 160mL. Most babies get 3.5mL (about 10mg) per dose, at least 2 times per day. We recommend 3 doses per day for babies under 1 year of age and over 1 month. This gives you approx 15 days worth of med. That will end up costing $1.35 per day (approx). $492 per year.


Ingredients in BB:

Side B: Dicalcium phosphate, guar gum
Side A: Sugar from cane, flavors, guar gum, sodium bicarbonate, micronized calcium carbonate, calcium phosphate
ingredients of Packet A has 45% Calcium phosphate ,30% Calcium carbonate, 20% sodium bicarbonate, 5% dicalcium phosphate


Stability of BB:

24 hours - A and B can be mixed together
12 hours - left at room temperature
4 hours - mixed into a bottle
24 hour stability experiment of Prevacid, Omeprazole, Nexium in bufferbabies (A and B mixed together), stored refrigerated and at room temperature + light.
In 24 hours all were stable, no degradation.



What am I doing? How to describe to GI:

You are making a liquid that contains a balance of buffers and omeprazole. The buffers protect the omeprazole from acid degradation (in lieu of enteric-coating) and the combination of three buffers (sodium bicarb, calcium carbonate and magnesium hydroxide) minimizes excess gas from sodium bicarbonate. The buffers stimulate acid secreting pumps (the proton pumps) the parietal cells to "turn on" so that the omeprazole can shut them off. Proton pump inhibitors (such as omeprazole, lansoprazole, etc.) only inhibit the proton pumps that are "on".
The immediate release suspension (contains no granules - which are hard for baby to orally deal with) allows you to dose without regard to meals, and can be added to the bottle or formula (if that is convenient).



**Tips to getting BB in your baby without lots of spit up:

Break it into two smaller doses-As long as you give the two smaller doses within 1 hr of each other, for example in your case, give 2.5mL then in 45 minutes give 2 mL.




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