Oral erythromycin and feeding intolerance in preterm infants

authors:

avatar Amir-Mohammad Armanian , * , avatar Ashraf Sadat Mousavi , avatar Nima Salehimehr

Koomesh: Vol.21, issue 1; 116-122
published online: March 05, 2019
article type: Research Article
received: January 03, 2018
accepted: September 05, 2018

how to cite: Armanian A, Mousavi A S, Salehimehr N. Oral erythromycin and feeding intolerance in preterm infants. koomesh. 2019;21(1):e153046. 

Abstract

Introduction: Milk intolerance is a common problem in a preterm neonate with low birth weight, which results in the need to feed through the vessel with its many complications. Erythromycin is an antibiotic with prokinetic properties that can have beneficial effects in the treatment of this disorder. This study was performed to evaluate the effect of moderate dose erythromycin on the treatment of intolerance to nutrition in preterm infants. Materials and Methods: In this randomized clinical trial, the neonates were randomly divided into two groups receiving erythromycin (20 mg/kg/day) or placebo, and the number of cases of milk intolerance (milk lavage), milk filling time, necrotizing enterocolitis, duration of hospitalization, probable complications of erythromycin, such as hypertrophic pyloric stenosis, and other cases were compared in both groups. Results: 64 preterm infants with the mean gestational age of 30.1 ± 2.49 weeks were studied. The number of milk intolerance and the mean milk filling time (150 cc/kg/day) were significantly lower in the erythromycin group than in the control group (P0.05). Conclusion: Erythromycin with a moderate dose was effective in reducing the incidence of milk intolerance and improving the mean time to reach the full volume of milk in premature neonates with low birth weight, and it appeared to be a safe drug for these neonates.  

References

  • 1.

    Moreno Villares JM. Parenteral nutrition-associated liver disease. NutrHosp 2008; 23: 25-33.

  • 2.

    Tazuke Y,Teitelbaum DH.Alteration of canalicular transporters in a mouse model of total parenteral nutrition.J PediatrGastroenterolNutr2009; 48: 193-202.

  • 3.

    Partovi S, Kianifar HR, GholamiRobatsangi M,Ghorbani Z, Saeidi R. Evaluation of massage with oil containing medium chain triglyceride on weight gaining in preterm. Koomesh 2009; 11: 1-6. (Persian).

  • 4.

    Keshavarz M, KianiA, Nasani L, Agha Hossaini F. Effect of touch therapy by mothers on weight gaining of preterm newborns. Koomesh 2012; 13: 240-246. (Persian).

  • 5.

    Ng PC. Use of oral erythromycin for the treatment of gastrointestinal dysmotilityin preterm infants. Neonatology 2009; 95: 97-104.

  • 6.

    Kelly DA. Liver complications of pediatric parenteral nutritionepidemiology. Nutrition 1998; 14: 153-157.

  • 7.

    Andorsky DJ, Lund DP, Lillehei CW, Jaksic T, Dicanzio J, Richardson DS, et al. Nutritional and other postoperative management of neonates with short bowel syndrome correlates with clinical outcomes. J Pediatr 2001; 139: 27-33.

  • 8.

    Stenson BJ, Middlemist L, Lyon AJ. Influence of erythromycin on establishment of feeding in preterm infants: observations from a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed1998; 79: F212-F214.

  • 9.

    Ng PC, Fok TF, Lee CH, Wong W, Cheung KL. Erythromycin treatment for gastrointestinal dysmotility in preterm infants. J Paediatr Child Health 1997; 33: 148-150.

  • 10.

    Patole SK, Almonte R, Kadalraja R, Tuladhar R, Muller R, Whitehall JS. Can prophylactic oral erythromycin reduce time to full enteral feeds in preterm neonates? Int J ClinPract 2000; 54: 504-508.

  • 11.

    Oei J,Lui K.A placebocontrolled trial of lowdose erythromycin to promote feed tolerance in preterm infants.ActaPaediatr 2001; 90: 904-908.

  • 12.

    ElHennawy AA, Sparks JW, Armentrout D, Huseby V, Berseth CL. Erythromycin fails to improve feeding outcome in feeding-intolerant preterm infants. J PediatrGastroenterolNutr 2003; 37: 281-286.

  • 13.

    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 PediatrGastroenterolNutr 2003; 37: 554-558.

  • 14.

    Cairns P, et al. Randomised controlled trial of low-dose erythromycin in preterm infants with feed intolerance. in Pediatric Research. 2002. Int Pediatric Research Foundation,Inc 351 West Camden ST, Baltimore MD 21201-2436 USA.

  • 15.

    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.

  • 16.

    Nuntnarumit P, Kiatchoosakun P, Tantiprapa W, Boonkasidecha S. Efficacy of oral erythromycin for treatment of feeding intolerance in preterm infants. J Pediatr 2006; 148: 600-605.

  • 17.

    Ng PC1, So KW, Fung KS, Lee CH, Fok TF, Wong E, et al.Randomised controlled study of oral erythromycin for treatment of gastrointestinal dysmotility in preterm infants. Arch Dis Child Fetal Neonatal Ed 2001; 84: F177-F182.

  • 18.

    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: 1726-1739.

  • 19.

    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. PediatrNeonatol 2012; 53: 34-40.

  • 20.

    Ng E, Shah VS.Erythromycin for the prevention and treatment of feeding intolerance in preterm infants.Cochrane Database Syst Rev 2008; 3:CD001815.

  • 21.

    Hawkyard CV, Koerner RJ. The use of erythromycin as a gastrointestinal prokinetic agent in adult critical care: benefits versus risks. J AntimicrobChemother 2007; 59: 347-358.

  • 22.

    Peeters TL. Erythromycin and other macrolides as prokinetic agents. Gastroenterology 1993; 105: 1886-1899.

  • 23.

    Di Lorenzo C, Flores AF, Tomomasa T, Hyman PE. Effect of erythromycin on antroduodenal motility in children with chronic functional gastrointestinal symptoms. Dig Dis Sci 1994; 39: 1399-1404.

  • 24.

    Jadcherla SR, Klee G, Berseth CL. Regulation of migrating motor complexes by motilin and pancreatic polypeptide in human infants. Pediatr Res 1997; 42: 365-369.

  • 25.

    Mohammadizadeh M, Ghazinour M, Iranpour R. Efficacy of prophylactic oral erythromycin to improve enteral feeding tolerance in preterm infants: a randomised controlled study. Singapore Med J 2010; 51: 952-956.

  • 26.

    So KW, Ng PC.Erythromycin and gastrointestinal dysmotility in preterm infants. Eastern J Med 2010; 15: 146-150.

  • 27.

    Su BH, Lin HC.Erythromycin for treatment of feeding intolerance in preterm infants. J Pediatr 2007; 150: e30.

  • 28.

    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-F306.