Erythromycin for Feeding Intolerance

Aly H, Abdel-Hady H, Khashaba M, et al. Erythromycin and feeding intolerance in premature infants: a randomized trial. Journal of Perinatology (Jan 2007); 27 : 39–43. Full Text | PDF

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 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=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.

Comments: Erythromycin is a motilin agonist that has prokenetic effects on GI motility. This study found that low-dose oral erythromycin (3 mg/kg/day) can be used to treat feeding intolerance in formula-fed premature infants > 32 weeks gestation. Infants less than 32 weeks gestation do not appear to benefit from this treatment. This study did not look at potential adverse effects of this treatment. In particular, erythromycin has been associated with the development of pyloric stenosis in infants. I urge caution until the safety of this treatment has been established. ABK.

Dear colleagues, It was rather a routine practice in my unit to prescribe EES for feeding intolerance for the past 6 years. Results were encouraging. Fortunately we do not even have a single case of pyeloric stenosis related to EES. Could it be PS is merely coincident. Thanks

UserName: Dr. Ismail Haron
Institution: NICU, Hospital Sungai Buloh, Malaysia
telephone: 603 - 6145 4333
email: ismail_2327@yahoo.com.au

You may add your own comments to the discussion of this topic by selecting : Submit Comments.