Erythromycin as a prokinetic agent in preterm neonates - A systematic review

Sanjay K Patole ^1*, Shripada Rao ² and Dorota Doherty ³

¹ Neonatal Paediatrics, KEM Hospital for Women,, University of Western Australia, Perth, Australia
² Neonatal Paediatrics, KEM Hospital for Women, Perth, Australia
³ Women and Infants Research Foundation at King Edward Memorial Hospital for Women and School of Women, Australia

^* To whom correspondence should be addressed. E-mail: skpatole{at}hotmail.com.

Accepted 23 January 2005

Abstract

Background:It often takes several days or even weeks to establish full enteral feeds (FEF) in preterm, especially extremely low birth weight neonates due to feed intolerance related to gastrointestinal hypomotility. Clinical trials of erythromycin as a prokinetic agent in preterm neonates have reported conflicting results.

Aim:To systematically review the efficacy and safety of erythromycin as a prokinetic agent in preterm neonates.

Methods:Only randomised-controlled trials in preterm neonates (gestation 37 weeks) were considered eligible for inclusion. The primary outcome was the time to reach FEF of 150ml/kg/day. The secondary outcomes included the incidence of erythromycin related adverse effects such as diarrhea, cardiac arrythmias, and hypertrophic pyloric stenosis. No restrictions were applied on the dose (low: 3-12mgm.kg/day, antimicrobial: 12mgm/kg/6-8 hours), route (oral or intravenous), and mode (prophylactic or rescue) of administration. The standard methodology for systematic reviews was followed. A subgroup analysis was preplanned based on the dose and mode of drug administration.

Results:Seven trials (prophylaxis: 3, rescue: 4) with varying dosages,routes-modes of administration, and durations of erythromycin treatment and different results were found eligible for inclusion in the analysis. Meta analysis could not be performed, as specific data was either inadequate or not available.

Conclusion:The conflicting trial results may be explained by differences in dose, route, and mode of administration of erythromycin and in gastrointestinal motor responses in presence of different feeding conditions (eg. fasting vs fed state, intermittent vs continuous feeds). The implications of gestational and postnatal ages during erythromycin treatment are also important.

Keywords: enteral, erythromycin, feeding, preterm

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