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Erythromycin and feeding intolerance in premature infants: a randomized trial

Journal of Perinatology volume 27, pages 39–43 (2007)Cite this article

Abstract

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 ⩽32 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 χ2 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=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 ⩽32 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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References

  1. Ng PC, So KW, Fung KSC, Lee CH, Fok TF, Wong E et al. Randomized controlled study of oral erythromycin for treatment of gastrointestinal dysmotility in preterm infants. Arch Dis Child Fetal Neonatal Ed 2001; 84: F177–F182.

    Article  CAS  Google Scholar 

  2. Barnett CP, Omari T, Davidson GP, Goodchild L, Lontis R, Dent J et al. Effect of cisapride on gastric emptying in premature infants with feed intolerance. J Pediatr Child Health 2001; 37: 559–563.

    Article  CAS  Google Scholar 

  3. Su BH, Lin HC, Peng CT, Tsai CH . Effect of erythromycin on feeding intolerance in very low birth weight infants: a preliminary observation. Acta Pediatr Sin 1998; 39: 324–326.

    CAS  Google Scholar 

  4. Aanpreung P, Vajaradul C . Clinical use of erythromycin in children with gastrointestinal dysmotility. J Med Assoc Thai 2001; 84: 1021–1026.

    CAS  PubMed  Google Scholar 

  5. Kubota M, Nakamura T, Motokura T, Mori S, Nishida A . Erythromycin improves gastrointestinal motility in extremely low birth weight infants. Acta Paediatr Jpn 1994; 36: 198–201.

    Article  CAS  Google Scholar 

  6. Berne JD, Norwood SH, McAuley CE, Vallina VL, Villareal D, Weston J et al. Erythromycin reduces delayed gastric emptying in critically ill trauma patients: a randomized, controlled trial. J Trauma 2002; 53: 422–425.

    Article  CAS  Google Scholar 

  7. Patole S, Rao S, Doherty D . Erythromycin as a prokinetic agent in preterm neonates: a systematic review. Arch Dis Child Fetal Neonatal Ed 2005; 90: 301–306.

    Article  Google Scholar 

  8. Ballard J, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R . New Ballard Score, expanded to include extremely premature infants. J Pediatr 1991; 119: 417–423.

    Article  CAS  Google Scholar 

  9. Costalos C, Gounaris A, Varhalama E, Kokori F, Alexiou N, Kolovou E . Erythromycin as a prokinetic agent in preterm infants. J pedaitr Gastroenterol Nutr 2002; 34: 23–25.

    Article  CAS  Google Scholar 

  10. Nogami K, Nishikubo T, Minowa H, Uchida Y, Kamitsuji H, Takahashi Y . Intravenous low-dose erythromycin administration for infants with feeding intolerance. Pediatr Int 2001; 43: 605–610.

    Article  CAS  Google Scholar 

  11. Parkman H, Pagano AP, Vozzelli MA, Ryan JP . Gastrokinetic effects of erythromycin: myogenic and neurogenic mechanisms of action in rabbit stomach. Am J Physiol 1995; 269: G418–G426.

    CAS  PubMed  Google Scholar 

  12. Otterson M, Sarna SK . Gastrointestinal motor effects of erythromycin. Am J Physiol 1990; 259: G355–G363.

    CAS  PubMed  Google Scholar 

  13. Janssens J, Peeters TL, Vantrappen G, Tack J, Urbain JL, De Roo M et al. Improvement of gastric emptying in diabetic gastroparesis by erythromycin. Preliminary studies. Engl J Med 1990; 322: 1028–1031.

    Article  CAS  Google Scholar 

  14. Bruley des Varannes S, Parys V, Ropert A, Chayvialle JA, Roze C, Galmiche JP . Erythromycin enhances fasting and postprandial proximal gastric tone in humans. Gastroenterology 1995; 109: 32–39.

    Article  CAS  Google Scholar 

  15. Fraser R, Shearer T, Fuller J, Horowitz M, Dent J . Intravenous erythromycin overcomes small intestinal feedback on antral, pyloric, and duodenal motility. Gastroenterology 1992; 103: 114–119.

    Article  CAS  Google Scholar 

  16. Jadcherla SR, Berseth CL . Effect of erythromycin on gastroduodenal contractile activity in developing neonates. J Pediatr Gastroenterol Nutr 2002; 34: 16–22.

    Article  CAS  Google Scholar 

  17. Orenstein S . Erythromycin and gastroduodenal contractile activity. Curr Gastroenterol Rep 2002; 4: 227–228.

    Article  Google Scholar 

  18. Tomomasa T, Miyazaki M, Koizumi T, Kuroume T . Erythromycin increases gastric antral motility in human premature infants. Biol Neonate 1993; 63: 349–352.

    Article  CAS  Google Scholar 

  19. Dellagrammaticas HD, Iacovidou N, Megaloyanni E, Papadimitriou M, Kapetanakis J . Effect of low-dose oral erythromycin on gastric aspirates in ventilated neonates less than 32 weeks of gestation. Preliminary results. Biol Neonate 2002; 81: 213–216.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Neonatology, The George Washington University Hospital, Washington, DC, USA

    H Aly

  2. Department of Neonatology, Mansoura University Children's Hospital, Mansoura, Egypt

    H Abdel-Hady, M Khashaba & N El-Badry

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  1. H Aly
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  2. H Abdel-Hady
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  3. M Khashaba
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Correspondence to H Aly.

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Aly, H., Abdel-Hady, H., Khashaba, M. et al. Erythromycin and feeding intolerance in premature infants: a randomized trial. J Perinatol 27, 39–43 (2007). https://doi.org/10.1038/sj.jp.7211618

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