Randomised controlled study of oral erythromycin for treatment of gastrointestinal dysmotility in preterm infants

Abstract

Aim-To evaluate the eVectiveness of oral erythromycin as a prokinetic agent for the treatment of moderately severe gastrointestinal dysmotility in preterm very low birthweight infants. Methods-A prospective, double blind, randomised, placebo controlled study in a tertiary referral centre of a university teaching hospital was conducted on 56 preterm infants (< 1500 g) consecutively admitted to the neonatal unit. The infants were randomly allocated by minimisation to receive oral erythromycin (12.5 mg/kg, every six hours for 14 days) or an equivalent volume of placebo solution (normal saline) if they received less than half the total daily fluid intake or less than 75 ml/kg/day of milk feeds by the enteral route on day 14 of life. The times taken to establish half, three quarters, and full enteral feeding after the drug treatment were compared between the two groups. Potential adverse eVects of oral erythromycin and complications associated with parenteral nutrition were assessed as secondary outcomes. Results-Twenty seven and 29 infants received oral erythromycin and placebo solution respectively. The times taken to establish half, three quarters, and full enteral feeding after the drug treatment were significantly shorter in the group receiving oral erythromycin than in those receiving the placebo (p < 0.05, p < 0.05 and p < 0.0001 respectively). There was also a trend suggesting that more infants with prolonged feed intolerance developed cholestatic jaundice in the placebo than in the oral erythromycin group (10 v 5 infants). None of the infants receiving oral erythromycin developed cardiac dysrhythmia, pyloric stenosis, or septicaemia caused by multiresistant organisms. Conclusions-Oral erythromycin is eVective in facilitating enteral feeding in preterm very low birthweight infants with moderately severe gastrointestinal dysmotility. Treated infants can achieve full enteral feeding 10 days earlier, and this may result in a substantial saving on hyperalimentation. However, until the safety of erythromycin has been confirmed in preterm infants, this treatment modality should remain experimental.Prophylactic or routine use of this medication for treatment of mild cases of gastrointestinal dysmotility is probably not warranted at this stage. (Arch Dis Child Fetal Neonatal Ed 2001;84:F177-F182)

Erythromycin and feeding intolerance in premature infants: a randomized trial

“…1 Procedural pain associated with prolonged intravenous hyperalimentation seems a minor issue when performed with proper anesthesia and analgesia. However, these infants can present with serious and even life-threatening complications that include liver dysfunction and bloodstream infections.…”

“…However, these infants can present with serious and even life-threatening complications that include liver dysfunction and bloodstream infections. 1 Establishing enteral feeding is therefore a critical milestone during management of premature infants. As feeding intolerance in premature infants is mainly functional, prokinetic drugs have been used with increasing frequency in newborn infants.…”

A controlled trial of erythromycin and UDCA in premature infants during parenteral nutrition in minimizing feeding intolerance and liver function abnormalities

“…Our study demonstrated that erythromycin-treated infants had significantly fewer episodes of large residual gastric aspirates and were able to attain FEF more quickly, as noted in other. 24,26 Thus, we suggest that the use of an intermediate dose of oral erythromycin could significantly reduce the number of withheld feeds and the time of FEF. 23 The main limitation of our study was that it was underpowered.…”

Efficacy of oral erythromycin to enhance feeding tolerance in preterm infants

“…7,17,18 One study found a significant benefit with high-dose erythromycin (12.5 mg/kg q.i.d) compared to placebo for treating feeding intolerance in preterm infants with birth weight <1,500 grams [13.5 (8-22) vs. 25 (16-33) days, respectively]. 5 Also, Madani et al reported that a significant benefit was found in preterm infants >32 weeks who took highdose erythromycin (12.5 mg/kg q.i.d) compared to placebo. 2 Similarly, Aly et al found a significant benefit in preterm infants >32 weeks [10.5 (4.1) vs. 16.3 (5.7) days, respectively, with low-dose erythromycin (1 mg/ kg t.i.d) compared to placebo.…”

“…This macrolide has a motilin-like effect and stimulates peristalsis. 1,5 Erythromycin works as a motiline agent, by binding to the motiline receptor at the antrum and upper duodenum and leading to increased contractions in the antrum. 4,6 The motiline hormone stimulates the gastric emptying process and induces phase III of migrating motor complexes (MMC) in the proximal intestine, reducing transit time in the intestine.…”