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a Department of
Paediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, b Department of
Microbiology, c Centre for Clinical Trials and Epidemiological
Research
Correspondence to: Professor Ng, Department of Paediatrics, Level 6, Clinical Sciences Building, Prince of Wales Hospital, Shatin, NT, Hong Kong pakcheungng{at}cuhk.edu.hk
Accepted 4 January
2001
AIM
To evaluate the
effectiveness of oral erythromycin as a prokinetic agent for the
treatment of moderately severe gastrointestinal dysmotility in preterm
very low birthweight infants.
METHODSA prospective,
double blind, randomised, placebo controlled study in a tertiary
referral centre of a university teaching hospital was conducted on 56 preterm infants (< 1500 g) consecutively admitted to the neonatal
unit. The infants were randomly allocated by minimisation to receive
oral erythromycin (12.5 mg/kg, every six hours for 14 days) or an
equivalent volume of placebo solution (normal saline) if they received
less than half the total daily fluid intake or less than 75 ml/kg/day
of milk feeds by the enteral route on day 14 of life. The times taken
to establish half, three quarters, and full enteral feeding after the
drug treatment were compared between the two groups. Potential adverse
effects of oral erythromycin and complications associated with
parenteral nutrition were assessed as secondary outcomes.
RESULTSTwenty seven
and 29 infants received oral erythromycin and placebo solution
respectively. The times taken to establish half, three quarters, and
full enteral feeding after the drug treatment were significantly
shorter in the group receiving oral erythromycin than in those
receiving the placebo (p < 0.05, p < 0.05 and p < 0.0001
respectively). There was also a trend suggesting that more infants with
prolonged feed intolerance developed cholestatic jaundice in the
placebo than in the oral erythromycin group (10 v 5 infants). None of the infants receiving
oral erythromycin developed cardiac dysrhythmia, pyloric stenosis, or
septicaemia caused by multiresistant organisms.
CONCLUSIONSOral
erythromycin is effective in facilitating enteral feeding in preterm
very low birthweight infants with moderately severe gastrointestinal
dysmotility. Treated infants can achieve full enteral feeding 10 days
earlier, and this may result in a substantial saving on
hyperalimentation. However, until the safety of erythromycin has been
confirmed in preterm infants, this treatment modality should remain
experimental. Prophylactic or routine use of this medication for
treatment of mild cases of gastrointestinal dysmotility is probably not
warranted at this stage.
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