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Erythromycin for feeding intolerance in preterm infants
1Division of Neonatology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8. eugene.ng@sickkids.on.ca
Background:
Functional immaturity of gastointestinal motility predisposes preterm infants to feeding intolerance. Motilin, a gastrointestinal peptide, stimulates propagative contractile activity during phase III of the migratory motor complex in the interdigestive state. Erythromycin (EM) is a motilin agonist with prokinetic effect at low doses (1-3mg/kg).
Objectives:
To evaluate the effectiveness of EM in promoting gastrointestinal motility in preterm infants with feeding intolerance and assess clinically significant adverse effects associated with its use.
Search Strategy:
Systematic literature search in accordance with the Cochrane Neonatal Collaborative Review Group search strategy. Randomized and quasi-randomized controlled trials of EM use, at any dose, in preterm infants to promote gastrointestinal motility were identified by searching MEDLINE, EMBASE, CINAHL, the Cochrane Library, reference lists of published studies, personal files, and abstracts published in Pediatric Research.
Selection Criteria:
Randomized controlled trials of oral or intravenous EM use at dose range of 3 to 12 mg/kg/day in preterm infants less than or equal to 36 weeks gestational age with feeding tolerance were included in this review.
Data Collection And Analysis:
Data regarding the primary clinical outcome of days to achieve full enteral feeding were compared among studies. Data on secondary outcomes including adverse effects associated with the use of EM (diarrhea, nosocomial infections, cardiac arrhythmias, or theophylline toxicity), duration of parenteral nutrition, weight gain, incidence of necrotizing enterocolitis (NEC), hypertrophic pyloric stenosis, and length of hospital stay were assessed.
Main Results:
Two randomized controlled studies of EM use in preterm infants for improving gastrointestinal motility were identified. Since both studies involved preterm infants treated with EM at dose >12mg/kg/day at commencement of feeding, they did not meet inclusion criteria defined a priori for this review. There was no statistically significant difference in the incidence of NEC (RR 0.59, 95%CI 0.11, 3.01; RD -0.021, 95%CI -0. 087, 0.045). No statistically significant difference was noted in days to achieve full enteral feeds, length of hospital stay, and adverse events between groups.
Reviewer'S Conclusions:
EM at antimicrobial doses may not be effective in preterm infants with feeding intolerance. Further studies are needed to determine whether EM in lower doses is effective as a prokinetic agent in such infants.
Insights
Erythromycin (EM) at higher doses did not improve gastrointestinal motility or reduce feeding intolerance in preterm infants. Further research is needed to assess EM
Area of Science:
- Neonatal Medicine
- Gastroenterology
- Pharmacology
Background:
- Preterm infants often experience feeding intolerance due to immature gastrointestinal motility.
- Motilin peptide agonists, like Erythromycin (EM), can stimulate gut motility.
- Low-dose EM (1-3mg/kg) shows prokinetic effects.
Purpose of the Study:
- To assess Erythromycin's effectiveness in enhancing gastrointestinal motility in preterm infants with feeding intolerance.
- To evaluate adverse effects of Erythromycin use in this population.
Main Methods:
- A systematic literature search was conducted using established neonatal review group strategies.
- Included were randomized and quasi-randomized controlled trials of EM in preterm infants (<36 weeks gestational age).
- Studies focused on oral or IV EM at doses of 3-12 mg/kg/day, assessing outcomes like time to full enteral feeding and adverse events.
Main Results:
- Two randomized controlled trials were identified but excluded as EM doses exceeded the a priori defined criteria (>12mg/kg/day).
- No significant differences were found in necrotizing enterocolitis (NEC) incidence, time to full enteral feeds, hospital stay, or adverse events between groups.
- The review could not establish EM's efficacy at antimicrobial doses for improving feeding tolerance in preterm infants.
Conclusions:
- Erythromycin administered at antimicrobial doses may not be effective for treating feeding intolerance in preterm infants.
- Further investigation is required to determine if lower doses of EM can serve as a prokinetic agent in this vulnerable population.