Efficacy of oral erythromycin to enhance feeding tolerance in preterm infants

Main Article Content

Made Sukmawati
Rinawati Rohsiswatmo
Rulina Suradi
Pramita Gayatri

Abstract

Background Feeding intolerance is a common condition that affects preterm infants. Erythromycin is a prokinetic agent used to treat feeding intolerance, but its efficacy remains inconclusive.

Objective To evaluate the effectiveness of oral erythromycin to enhance feeding tolerance in preterm infants.

Methods This prospective, randomized controlled trial in preterm infants was conducted at Sanglah Hospital, Denpasar, Bali, from June 2015 to January 2016. Eligible infants were randomized to receive either 12.5 mg/kg/dose oral erythromycin or a placebo, every 8 hours. The primary outcome was the time to establish full enteral feeding. The secondary outcomes were body weight at full enteral feeding and length of hospital stay.

Results Of 62 initial subjects, 3 infants dropped out of the study. Thirty infants were given erythromycin and 29 infants were given placebo. The baseline characteristics of the two groups were similar, with mean of gestational ages of 31.4 (SD 1.7) weeks in the erythromycin group and 32.4 (SD 2.2) weeks in the placebo group. The median times to reach full enteral feeding did not significantly differ between the two groups, with 10 (SD 5.3) days in the erythromycin group vs. 8 (SD 6.5) days in the placebo group (P=0.345). Also, median body weights at full enteral feeding and lengths of hospital stay were not significantly different between the two groups.

Conclusion Erythromycin of 12.5 mg/kg/dose every 8 hours as prophylactic treatment does not significantly enhance feeding tolerance in preterm infants. Median body weights at full enteral feeding and length of hospital stay are not significantly different between the erythromycin and placebo groups.

Article Details

How to Cite
1.
Sukmawati M, Rohsiswatmo R, Suradi R, Gayatri P. Efficacy of oral erythromycin to enhance feeding tolerance in preterm infants. PI [Internet]. 22Jun.2017 [cited 13Dec.2018];57(3):154-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/1320
Section
Articles
Author Biographies

Made Sukmawati, Department of Child Health, Udayana University Medical School/Sanglah Hospital, Denpasar, Bali

Neonatology department, Department of Child Health, Medical School, Udayana University, Sanglah Hospital

Rinawati Rohsiswatmo, Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta

Neonatology department, Department of Child Health, Medical School, Indonesia University

Rulina Suradi, Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta

Neonatology department, Department of Child Health, Medical School, Indonesia University

Pramita Gayatri, Department of Child Health, University of Indonesia Medical School/Dr. Cipto Mangunkusumo Hospital, Jakarta

Neonatology department, Department of Child Health, Medical School, Indonesia University

References

1. Aly H, Abdel-Hady H, Khashaba M, El-Badry N. Erythromycin and feeding intolerance in premature infants: a randomized trial. J Perinatol. 2007;27:39-43.
2. Madani A, Pishva N, Pourarian SH, Zarkesh M. The efficacy of oral erythromycin in enhancement of milk tolerance in premature infants: a randomized clinical trial. Iran J Med Sci. 2004;29:1-4.
3. Nguyen NQ, Chapman MJ, Fraser R, Bryant LK, Holloway RH. Erythromycin is more effective than metocloperamide in the treatment of feed intolerance in critical illness. Crit Care Med. 2007;35:483-9.
4. Harahap LI, Aminullah A, Pardede SO, Hegar B. Peran eritromisin terhadap toleransi minum bayi kurang bulan. Sari Pediatri. 2013;15:167-73.
5. Ng PC, So KW, Fung KS, Lee CH, Fok TF, Wong W, et al. Randomized controlled study of oral erythromycin for treatment of gastrointestinal dysmotility in preterm infant. Arch Dis Child Fetal Neonatal Ed. 2001;84:F177-82.
6. So KW, Ng PC. Erythromycin and gastrointestinal dysmotility in preterm infants. Eastern J Med. 2010;15:146-50.
7. Ng SC, Gomez JM, Rajadurai VS, Saw SM, Quak SH. Establishing enteral feeding in preterm infants with feeding intolerance: a randomized controlled study of low-dose erythromycin. J Pediatr Gastroenterol Nutr. 2003;37:554–8.
8. Costalos C, Gounaris A, Varhalama E, Kokori F, Alexiou N, Kolovou E. Erythromycin as a prokinetic agent in preterm infants. J Pediatr Gastroenterol Nutr. 2002;34:23-5.
9. Stenson BJ, Middlemist L, Lyon AJ. Influence of erythromycin on establishment of feeding in preterm infants: observations from a randomized controlled trial. Arch Dis Child Fetal Neonatal Ed. 1998;79:F212–14.
10. Neu J, Li N. The neonatal gastrointestinal tract: developmental anatomy, physiology, and clinical implications. NeoReviews. 2003;4e7-12.
11. 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:F301-6.
12. Lam HS, Ng PC. Use of prokinetics in preterm infants. Curr Opin Pediatr. 2011;23:156-60.
13. Mohammadizadeh M, Ghazinour M, Iranpour R. Efficacy of prophylactic oral erythromycin to improve enteral feeding tolerance in preterm infants: a randomized controlled study. Singapore Med J. 2010;51:952-6.
14. Oei J, Lui K. A placebo-controlled trial of low-dose erythromycin to promote feed tolerance in preterm infants. Acta Paediatr. 2001;90:904-8.
15. Ng PC. Use of oral erythromycin for the treatment of gastrointestinal dysmotility in preterm infants. Neonatology. 2009;95:97-104.
16. Mansi Y, Abdelaziz N, Ezzeldin Z, Ibrahim R. Randomized controlled trial of a high dose of oral erythromycin for the treatment of feeding intolerance in preterm infants. Neonatology. 2011;100:290-4.
17. Elhenway AA, Sparks JW, Armentrout D, Huseby V, Berseth CL. Erythromycin fails to improve outcome in feeding-intolerant preterm infants. J Pediatr Gastroentrol Nutr. 2003;37:281-6.
18. Ng YY, Su PH, Chen JY, Quek YW, Hu JM, Lee IC, et al. Efficacy of intermediate-dose oral erythromycin on very low birth weight infants with feeding intolerance. Pediatr Neonatol. 2012;53:34-40.
19. Ng PC, Lee CH, Wong SP, Lam HS, Liu FY, So KW, et al. High-dose oral erythromycin decreased the incidence of parenteral nutrition-associated cholestasis in preterm infants. Gastroenterology. 2007;132:1726-39.
20. Nguyen NQ, Mei SL. Current issues on safety of prokinetics in critically ill patients with feed intolerance. Ther Adv Drug Saf. 2011;2:197-204.
21. Buck ML. Erythromycin as a gastrointestinal prokinetic agent in infants. Pediatr Pharmacother. 2010;16:1-4.
22. Lakritz J, Wilson DW. Erythromycin: pharmacokinetics, bioavailability, antimicrobial activity, and possible mechanisms associated with adverse reactions. Proceedings of the Annual Convention of the AAEP. 1997;43:83-6.