Effect of Low-Dose Oral Erythromycin on Gastric Aspirates in Ventilated Neonates Less than 32 Weeks of Gestation

Abstract

In this prospective study, the 24-hour gastric aspirate volume was carefully recorded before, 24 and 48 h after administering 1.7 mg/kg/8-hourly of oral erythromycin to 16 ventilated neonates less than 32 weeks of gestation. Their median gestational age was 28.5 weeks (range 23–31 weeks), their median birthweight was 1,045 g (range 690–1,560 g) and the median day of life at which erythromycin was commenced was 9.5 days (range 4–16 days). Prior to administering erythromycin median 24-hour gastric aspirate volume, expressed as a percentage of the milk volume given over the same period, was 38.5% (range 20.0–100%). It was significantly lower 24 h (median 12%, range 0–41%, p = 0.0004) and 48 h (median 5%, range 0–21%, p = 0.0004) after commencing erythromycin. There was also significant reduction of gastric aspirate volume between 24 and 48 h after commencing erythromycin (p = 0.0024). Milk volume increment over the same period was not significant (p = 0.1022). These preliminary results warrant further evaluation through a randomised controlled trial.

Erythromycin and feeding intolerance in premature infants: a randomized trial

“…This concept explains the contradicting finding in different trials on the use of erythromycin in premature infants. 10,19 In summary, low-dose oral erythromycin had beneficial effects on feeding intolerance and it shortened the duration of PN in preterm infants older than 32 weeks gestation. A similar effect was not found in younger preterm infants.…”

Efficacy of oral erythromycin for treatment of feeding intolerance in preterm infants

“…8,10,11,16 -21 The results are inconsistent and contradictory, making comparison with our findings difficult. The discrepancies are due to many factors, particularly the Placebo (n ‫؍‬ 23), median (IQR) P Time to full feeding (days) 7 (6,9) 13 (9,15) Ͻ0.001* Numbers of withheld feeds or gastric residuals Ͼ 50% 1 (0, 2) 9 (2, 13) Ͻ0.001* Duration of parenteral nutrition (days) 13 (11,15) 17 (13,25) 0.03* Day to regain birth weight (days) 11 (10,14) 12 (11,15) A recent systematic review conducted in 2005 found a total of 7 studies eligible for analysis. 12 Two of the 3 randomized controlled trials involving the prophylactic approach using an antimicrobial dose (45 mg/kg/day given intravenously in 1 study 13 and 48 mg/kg/day given enterally in the other study 14 ) showed no beneficial effect on feeding in preterm infants; however, the third study 15 using low-dose EM (10 mg/kg/day given orally) found EM to be useful.…”

Peran Eritromisin terhadap Toleransi Minum Bayi Prematur

“…19 Eritromisin dosis rendah dapat menurunkan volume residu lambung dan memperpendek waktu transit usus pada bayi prematur, sehingga waktu pencapaian pemberian nutrisi enteral penuh (full feed) lebih cepat. 20,21 Kami tidak mendapatkan perbedaan episode terjadinya residu pada kelompok eritromisin dan plasebo. Hasil tersebut serupa dengan uji klinis acak tersamar ganda yang dilakukan oleh ElHennawy dkk 22 di Texas yang melibatkan 26 bayi prematur dengan UG 29-36 minggu.…”