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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. eugeneng@canada.com
Background:
Functional immaturity of gastrointestinal 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 in preterm infants with feeding intolerance. More research is needed to determine if lower EM doses can act as a prokinetic agent in this population.
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.