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Establishing enteral feeding in preterm infants with feeding intolerance: a randomized controlled study of low-dose
Steven Chin-Yuen Ng1, Joseph Manuel Gomez, Victor Samuel Rajadurai
1Department of Neonatology, Children's Medical Institute, National University Hospital, Singapore. ngcy@nuh.com.sg
Insights
Low-dose erythromycin did not shorten the time to full enteral feedings for preterm infants with very low birth weight and feeding intolerance. Gastroesophageal reflux reduction was attributed to natural maturation, not the drug.
Area of Science:
- Neonatology
- Pediatric Gastroenterology
- Clinical Pharmacology
Background:
- Preterm infants with very low birth weight often experience feeding intolerance.
- Achieving full enteral feedings is crucial for infant growth and development.
- Gastroesophageal reflux is a common complication in this vulnerable population.
Purpose of the Study:
- To investigate the efficacy of low-dose erythromycin in accelerating the attainment of full enteral feedings.
- To assess the impact of erythromycin on feeding intolerance and gastroesophageal reflux in preterm infants.
Main Methods:
- A prospective, double-blind, randomized controlled trial was conducted.
- Two groups of preterm infants (birth weight ≤ 1500 g) with feeding intolerance received either low-dose erythromycin or placebo.
- The primary outcome was the time to achieve full enteral feedings (≥ 130 mL/kg/d).
Main Results:
- The mean time to full enteral feedings was 24.9 days in the erythromycin group versus 30.8 days in the placebo group (P = 0.17).
- Birth weight was lower and the incidence of small-for-gestational-age infants was higher in the erythromycin group.
- Symptomatic improvement of gastroesophageal reflux was similar between the groups.
Conclusions:
- Low-dose erythromycin did not significantly reduce the time to full enteral feedings in preterm infants with feeding intolerance.
- Gastroesophageal reflux improvement appears to be related to gastrointestinal maturation rather than erythromycin treatment.
- Larger multicenter trials are warranted to further investigate these findings.
Objective:
A prospective, double-blind, randomized, controlled trial was conducted to evaluate the effect of low-dose erythromycin on the time taken to attain full enteral feedings in preterm infants with very low birth weight and feeding intolerance.
Methods:
Two groups of preterm infants (birth weight
Results:
The gestational age at birth was similar in the two groups (erythromycin, 27.1 +/- 1.9 weeks; placebo, 27.5 +/- 2.9 weeks). The mean birth weight of the erythromycin group was lower (806.3 +/- 215.6 g) than the placebo group (981.4 +/- 285.4 g; P = 0.18), and included more infants who were small for gestational age (4/13 = 31% versus 1/11 = 9%; P = 0.224). There was no difference between the two groups with regard to the volume of feedings they were receiving at the time of enrollment. Reduction in symptoms of gastroesophageal reflux was similar in the two groups. 3 of 13 in the erythromycin group and 4 of 11 in the placebo group improved during the study (P = 0.565). The mean time to attain full enteral feedings after enrollment was 24.9 + 2.9 days in the erythromycin group and 30.8 +/- 4.1 days in the placebo group, a difference that did not reach statistical significance (P = 0.17).
Conclusions:
Low-dose erythromycin did not reduce the time taken to attain full enteral feedings in preterm infants with very low birth weight and feeding intolerance. Gastroesophageal reflux decreased as a consequence of maturation of the gastrointestinal tract and not because of erythromycin. These preliminary results justify verification in larger multicenter trials.
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