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Role of cisapride in preterm infants
  1. J S CRAIG,
  2. B G MCCLURE
  1. Department of Child Health
  2. The Queen’s University of Belfast
  3. Institute of Clinical Science
  4. Belfast BT12 6BJ
  5. Royal Maternity Hospital
  6. Belfast BT12 6BB
    1. T R J TUBMAN
    1. Department of Child Health
    2. The Queen’s University of Belfast
    3. Institute of Clinical Science
    4. Belfast BT12 6BJ
    5. Royal Maternity Hospital
    6. Belfast BT12 6BB

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      Editor—Enriquez et alprovided evidence that cisapride given to preterm infants was beneficial and free of side effects.1 A study of similar design, based in our unit, was halted by the Medicines Control Agency (MCA) because of the possible risks of prolonged QT intervals.2 It is therefore interesting to note that the publication of Enriquez’s study coincides with an update from the MCA. This states that cisapride is contraindicated in preterm infants up to the age of 3 months.3

      We recently undertook a survey of 367 neonatologists in the UK and Ireland to ascertain the prevalence of cisapride prescriptions in preterm infants and the indications for its use.4 Almost 70% of those surveyed responded to the questionnaire. The results showed that 85% of respondents continue to actively prescribe cisapride in their units while only 5% have stopped using it because of the risk of QT interval prolongation. The predominant indication for use was for gastrointestinal reflux (87%), but around 50% of respondents also used it for feed intolerance, gastric stasis, and intestinal dysmotility.

      Our survey shows that cisapride is still widely prescribed for preterm babies in the UK and Ireland. We urgently need clear risk: benefit data from randomised controlled trials. We suggest that the best way to clarify the role of cisapride in the care of preterm infants is by a large multicentre randomised controlled trial which investigates gut motility and oesophageal reflux, and includes serial ECG monitoring and pharmokinetic studies. We are concerned that without such a trial cisapride will continue to be widely used, perhaps placing infants at unnecessary risk.

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