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, a peptide hormone, enhances gut motility, and erythromycin (EM) acts as a motilin agonist with potential prokinetic effects at low doses.

Purpose of the Study:

• To assess the efficacy of erythromycin in enhancing gastrointestinal motility in preterm infants suffering from feeding intolerance.
• To identify any significant adverse effects linked to erythromycin use in this vulnerable patient group.

Main Methods:

• A systematic literature search was conducted following the Cochrane Neonatal Collaborative Review Group guidelines.
• Included were randomized and quasi-randomized controlled trials involving preterm infants (≤36 weeks gestational age) receiving oral or intravenous EM (3-12 mg/kg/day).
• Primary outcome was days to achieve full enteral feeding; secondary outcomes included adverse events, duration of parenteral nutrition, weight gain, NEC incidence, and length of hospital stay.

Main Results:

• Two randomized controlled studies were identified, but neither met the inclusion criteria due to EM doses exceeding 12 mg/kg/day.
• No significant differences were observed in necrotizing enterocolitis (NEC) incidence, time to full enteral feeds, hospital stay duration, or adverse events between groups.

Conclusions:

• Erythromycin administered at antimicrobial doses may not effectively promote gastrointestinal motility in preterm infants with feeding intolerance.
• Further investigation is required to ascertain the prokinetic efficacy of lower erythromycin doses in this patient population.