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Background: Oropharyngeal administration of mother's colostrum in early days has an immunoprotective effect in preterm infants. Objectives: Our aim was to study the effect of oropharyngeal administration of mother's milk (OPAMM) on decreasing the incidence of nosocomial sepsis. Methods: In a pilot prospective randomized study on preterm (<32 weeks gestation and 1500 g weight) infants, we compared OPAMM practice (applying 0.2 mL of mother's colostrum or milk prior to gavage feeding until full oral feeding is reached) with regular gavage feeding. The primary outcome was incidence of culture-proven nosocomial sepsis. Secondary outcomes included bacterial colonization of the gastrointestinal tract, feeding intolerance, time to reach full feeding, incidence of necrotizing enterocolitis, ventilator-associated pneumonia, duration of respiratory support, incidence of bronchopulmonary dysplasia (BPD), length of hospital stay, and neonatal mortality. Results: The outcomes of 200 neonates (100 in each group) were analyzed. OPAMM practice did not significantly reduce the incidence of culture proven nosocomial sepsis (8% vs 13%, P = 0.35). Infants in the OPAMM group had a significantly lower growth of Klebsiella species in the oropharyngeal pouch, borderline lower incidence of ventilator-associated pneumonia, shorter duration of oxygen therapy, less episodes of feeding intolerance, reached full feeding earlier, and had a shorter length of hospital stay. OPAMM practice did not affect the incidence of necrotizing enterocolitis, BPD, or neonatal mortality. Conclusion: OPAMM prior to gavage feeding does not reduce the incidence of nosocomial sepsis but had beneficial effects on early achievement of feeding, and early hospital discharge in preterm very low-birth-weight infants. (JPEN J Parenter Enteral Nutr. 2020;44:92-104) Clinical Relevancy StatementGavage feeding in preterm infants deprives the oropharyngeal pouch from the beneficial effect of mother's colostrum and milk. Previous reports have shown immunoprotective and anti-inflammatory effects for mother's colostrum when given early to the oropharyngeal pouch. We found that oropharyngeal administration of mother's milk prior to gavage feeding was associated with shorter duration to achieve full feeding, duration of oxygen support, and length of hospital stay in preterm infants.From the

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Objectives: To evaluate the effectiveness of low-dose oral erythromycin to treat feeding intolerance in preterm infants.Design: This study was a prospective, double-blind, randomized, placebo-controlled trial on 60 premature infants suffering from feeding intolerance. Thirty infants were given oral erythromycin 1 mg/kg every 8 h and 30 infants were given placebo (normal saline). Randomization was stratified on enrollment according to gestational age whether >32 weeks or p32 weeks. The primary end point was the length of time taken to establish full enteral feeding since enrollment. Potential adverse effects associated with erythromycin were also monitored. Groups of each corresponding stratum were compared using two-tail t-test and Mann-Whitney for continuous variables, and w 2 and Fisher's exact for categorical variables.Results: For infants with gestational age >32 weeks, the erythromycin group achieved full enteral feeding earlier than placebo group (10.5±4.1 vs 16.3±5.7 days, respectively; P ¼ 0.01) had fewer episodes of gastric residuals (P<0.05) and shorter duration of parenteral nutrition (PN) (P<0.05). On the other hand, in infants with gestational age p32 weeks, there were no significant differences between erythromycin and placebo groups regarding any of these variables.Conclusion: Low-dose enteral erythromycin is associated with better tolerance of feeding and shorter duration of PN in infants >32 weeks gestation. A similar effect on younger preterm infants was not demonstrable.

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