Erythromycin Fails to Improve Feeding Outcome in Feeding-Intolerant Preterm Infants

ElHennawy, Adel A.; Sparks, John W.; Armentrout, Debra; Huseby, Valerie; Berseth, Carol Lynn

doi:10.1097/00005176-200309000-00015

Cited by 33 publications

(41 citation statements)

References 25 publications

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“…In our study there was a decrease in GET in babies of all weights in the test group, but it was more in babies weighing > 2 kgs (Table 3). In a recent study by Ng et al [11], erythromycin in doses of 15mg/kg/day, did not improve feed tolerance in smaller and more preterm babies which has been collaborated by other studies [12]. Babies in our study were larger and more mature which explains the better results.…”

Section: Discussionsupporting

confidence: 70%

Effect of Erythromycin on Gastric Emptying Time of Low Birth Weight Babies

Mathai

Bawa

Bhandari³

2007

Medical Journal Armed Forces India

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Background: To study the promotility effects of low dose erythromycin on gastric emptying time in a population of normal low birth weight (LBW) neonates on breast feeds with or without nutritional supplements and human milk fortifier (HMF). Method: A randomised control trial involving 50 neonates was undertaken and they were given 6mg/kg/day of oral erythromycin or placebo in three divided doses for four consecutive days in the first two weeks of life. The gastric emptying time (GET) was assessed ultrasonographically by measuring the decrease in the antral cross sectional area (ACSA). The time taken for the ACSA to become half the prefeed value, was taken as t/2 or half GET. The babies were also assessed for pre and post intervention side effects of the drug. The results were analysed using SPSS ver 11.5. Results: The test group showed a significant decrease in GET after the intervention. This effect was mainly seen in the preterm babies as compared to term Small for Gestational Age (SGA) babies. The decrease in GET was more in babies born after 34 weeks of gestation as compared to smaller babies. The reduction in GET was seen in babies on breast milk alone and nutritional supplements with breast milk but not when HMF was added. No side effects of the drug were noted. Conclusion: Low dose erythromycin is a safe way of decreasing gastric emptying in preterm babies born after 34 weeks of gestation in the first two weeks of life. MJAFI 2007; 63 : 226-228

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Section: Discussionsupporting

confidence: 70%

Effect of Erythromycin on Gastric Emptying Time of Low Birth Weight Babies

Mathai

Bawa

Bhandari³

2007

Medical Journal Armed Forces India

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“…To date, 10 RCTs have reported effects of erythromycin on preterm newborns [10][11][12][13][14][15][16][17][18][19] . Seven RCTs used erythromycin as a rescue treatment [13][14][15][16][17][18][19] and 3 studies used the medication as a prophylactic prokinetic agent [10][11][12] . The characteristics of the study populations and findings of these RCTs are summarized in tables 1 and 2 .…”

Section: Review Of Rctsmentioning

confidence: 99%

“…Seven RCTs used erythromycin as a rescue treatment for preterm infants with feeding intolerance ( table 2 ) [13][14][15][16][17][18][19] . Four clinical trials used low doses (3-15 mg/kg/day administered either orally or intravenously) [13][14][15][16] , whereas the other 3 trials used either an intermediate/ high dose tapering regimen (40 mg/kg for 2 days followed by 16 mg/kg for 5 days) [17] or high doses (50 mg/day) [18,19] .…”

Section: Review Of Rctsmentioning

confidence: 99%

Use of Oral Erythromycin for the Treatment of Gastrointestinal Dysmotility in Preterm Infants

2008

Neonatology

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Milk intolerance due to functional gastrointestinal (GI) dysmotility is a common problem in preterm infants. In the past decade, erythromycin has been used for its motilinomimetric effect to facilitate enteral feeding in preterm infants. Although earlier studies suggested that erythromycin is an effective prokinetic agent, recent randomized control trials (RCTs) reveal conflicting findings. This review assesses the evidence from all RCTs performed to date on erythromycin for preterm infants. The results suggest that oral erythromycin administered in intermediate or high doses as a rescue treatment is associated with a shorter time to attain full enteral feeding and decrease in the duration of requirement for parenteral nutrition. More importantly, the outcome study further indicates that oral erythromycin can reduce the incidence of parenteral nutrition-associated cholestasis by almost 50% and decreases the incidence of recurrent septicemia. None of the RCTs reported any sinister adverse effects, in particular, hypertrophic infantile pyloric stenosis or fatal cardiac arrhythmia. Nonetheless, as long-term outcomes have not been fully evaluated, neonatologists should use this treatment cautiously and selectively in preterm infants with moderately severe GI dysmotility.

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“…However, most studies, including the recent trial by ElHennawy et al, 15 suggest that this treatment is not generally useful in reducing feeding intolerance in this population.…”

Section: Discussionmentioning

confidence: 99%

Enteral Administration of a Simulated Amniotic Fluid to Very Low Birth Weight Neonates

et al. 2005

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DO OBJECTIVE:To reduce feeding intolerance among very low birth weight neonates. STUDY DESIGN:A total of 10 neonates with birth weights of 750 to 1250 g were given oralgastric boluses (2.5 ml/kg every 3 hours) of a solution patterned after amniotic fluid. When milk feedings were begun the milk was mixed with the test solution. The solution was given at a constant daily dose of 20 ml/ kg/day while the volumes of milk feedings were gradually increased. When milk feedings reached 80 ml/kg/day the test solution was discontinued. A comparison group consisted of neonates who met study criteria but were cared for during the period immediately preceding the study. The outcome was the number of calories taken enterally over the first 21 days of life. RESULTS:The test solution was begun an average of 27 hours after birth (range, 4 to 45). In the test group the first milk feedings were introduced 74 hours after birth (range, 18 to 144), which was similar to the time milk was introduced in the comparison subjects (79 hours; range, 18 to 168). After milk feedings were started, the test patients had a total of four NPO days (0.4 NPO days per patient) during their first 21 days, while the comparison group had 34 NPO days (3.4 NPO days per patient). During the first 14 days of life the test solution recipients had a median of 26.5 enteral cal/kg/day (range, 4.3 to 68.9), while the comparison neonates had 8.5 (range, 0.2 to 25; p<0.05). During the first 21 days of life the test solution recipients had a median of 56.9 enteral cal/kg/day (range, 11.5 to 89.4), while the comparison neonates had 19.2 (range, 0.9 to 52.8; p<0.05). CONCLUSION:In all, 10 VLBW infants tolerated the test solution for periods up to 14 days with no significant adverse effects. A randomized trial to determine whether this solution reduces feeding intolerance among VLBW neonates should be conducted.

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Erythromycin Fails to Improve Feeding Outcome in Feeding-Intolerant Preterm Infants

Abstract: Intragastric erythromycin does not improve feeding tolerance in preterm infants with established feeding intolerance because it fails to improve gastrointestinal function in the short or long term.

Cited by 33 publications

References 25 publications

Effect of Erythromycin on Gastric Emptying Time of Low Birth Weight Babies

Effect of Erythromycin on Gastric Emptying Time of Low Birth Weight Babies

Use of Oral Erythromycin for the Treatment of Gastrointestinal Dysmotility in Preterm Infants

Enteral Administration of a Simulated Amniotic Fluid to Very Low Birth Weight Neonates

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