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Long-term use of cisapride (Prepulsid) in premature neonates
1Children's Hospital, Antwerpen.
Insights
Cisapride significantly reduced gastric stasis in premature neonates, improving feeding tolerance. The study found no evidence linking cisapride to cholestasis, suggesting its use is beneficial for premature infants with delayed gastric emptying.
Area of Science:
- Neonatal Medicine
- Pharmacology
Background:
- Premature neonates often experience gastric stasis, leading to feeding intolerance.
- Gastro-oesophageal reflux (GOR) is a common complication in this population.
- Delayed enteral feeding can negatively impact infant development.
Purpose of the Study:
- To investigate the efficacy of cisapride in treating gastric stasis in premature neonates.
- To assess the potential risk of cholestasis associated with cisapride use.
- To evaluate the impact of cisapride on feeding volumes and tolerance.
Main Methods:
- A study involving 20 premature neonates (gestational age 26-34 weeks) treated with cisapride (0.15 mg/kg q.i.d.) for a mean of 38 days.
- Gastric residue was measured during a 24-hour baseline and 48 hours of cisapride treatment.
- Patients received continuous nasogastric infusion of a semielementary formula.
Main Results:
- Cisapride treatment led to a significant decrease in mean gastric residue from 50.6% to 12.1% (p < 0.0001).
- Mean feeding volume increased significantly from 24.2 ml to 34.2 ml (p < 0.001).
- Four patients experienced reversible cholestasis, but a causal link to cisapride could not be established due to concurrent Candida outbreak.
Conclusions:
- Cisapride is effective in reducing gastric stasis and improving feeding volumes in premature neonates.
- The study did not demonstrate a causal relationship between cisapride and cholestasis.
- The benefits of using cisapride for premature neonates with gastric stasis outweigh the potential risks, especially considering the issues of GOR and delayed enteral feeding.
Abstract:
In order to study the effect of cisapride on gastric stasis and to evaluate the possible risk of cholestasis, 20 premature neonates born in the hospital during one year were orally treated with cisapride 0.15 mg/kg q.i.d., over a mean period of 38 days. The gestational age ranged from 26 to 34 weeks and the mean age at the start of the cisapride treatment was 18 days. All patients were ventilated, 13 had a respiratory distress syndrome (hyaline membrane disease), and 9 had gastro-oesophageal reflux (GOR). All patients were given a semielementary formula by means of a continuous nasogastric infusion. The gastric residue was studied during three days: 24 hour baseline and 48 hours under cisapride treatment. The mean residue decreased (p less than 0.0001) from 50.6% during the last 6 baseline hours to 12.1% during the last 6-hours of the cisapride period. The mean feeding volume increased from 24.2 ml to 34.2 ml (p less than 0.001). A group of four patients had reversible cholestasis against the background of an outbreak of Candida, three before and one during cisapride treatment. Therefore, it could not be demonstrated that cisapride plays a role in the development of cholestasis. Because of the risks of GOR and the drawbacks of delayed enteral feeding, it is concluded that the use of cisapride is justified in premature neonates with gastric stasis.
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