Erythromycin for feeding intolerance in preterm infants

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.