Can Prophylactic Oral Erythromycin Reduce Time to Full Enteral Feeds in Preterm Neonates?

Abstract

SUMMARYEfficacy of oral, prophylactic erythromycin in reducing the time to establish full enteral feeds (150 ml/kg/day) was assessed in neonates <32 weeks, ready for enteral feeds. Seventy‐three consecutive neonates were randomised to receive oral erythromycin ethyl succinate (n=36) or placebo (n=37) in a double‐blind trial until full enteral feeds or 14 days of therapy were reached. A prospectively designed feeding regimen, including plan of action for signs of feed intolerance, was common for all enrolled neonates. The median gestational age, birth weight and postnatal age at start of feeds were 29 versus 30 weeks (p=0.40), 1232 versus 1280 g (p=0.96) and 5 versus 5 days (p=0.84) for erythromycin and placebo group, respectively. Time to achieve full feeds was not significantly different in the two groups. (median times: erythromycin 93.5 versus placebo 104 hours, p=0.60). Erythromycin‐related side‐effects did not occur.

Erythromycin and Reflux Events in Premature Neonates

“…to 19 (15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33) and by 10 events in the placebo group to 19 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26) per 24 hours (P ¼ 0.09). In addition, there was also no significant difference in acidic reflux (P ¼ 0.14), nonacidic reflux (P ¼ 0.46), proximal reflux (P ¼ 0.54), total reflux time (P ¼ 0.502), percent reflux time (P ¼ 0.86), bolus clearance time (P ¼ 0.49), or longest bolus clearance time (P ¼ 0.92) in the pre and post pH-MII studies of both treatment groups (Figs.…”

“…EES and placebo subjects had a median (interquartile range) number of pretreatment ABD events of 19 (9.5-26.25) and 16.5 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24), respectively. ABD events decreased to 14 (4.75-19.5) in the EES group and to 10 (6-21) in the placebo group, which was not a statistically significant change (P ¼ 0.429) (Fig.…”

“…If greater than 5 reflux events (defined in the standard method as a retrograde change in electrical resistance between probe electrodes) were identified on pH-MII, then subjects were stratified by gestational age (<30 weeks,30-34 weeks and >35 weeks) and randomized to receive either placebo or erythromycin ethylsuccinate (EES) 50 mg Á kg À1 Á day À1 divided every 6 hours for 7 days. High-dose EES was chosen based on previous studies investigating feeding tolerance and time to full enteral feeds (14,(17)(18)(19). Placebo was 5% dextrose water prepared by the pharmacy in the same volume and syringe as to be visually indistinguishable from EES.…”

Use and Safety of Erythromycin and Metoclopramide in Hospitalized Infants

“…Other AEs of special interest in infants exposed to erythromycin include NEC and cardiac dysrhythmias. Previous randomized trials have demonstrated no significant differences in the incidence of NEC between infants treated with erythromycin and those given placebo (20)(21)(22)(23). Other studies found no increase in the incidence of cardiac arrhythmia, but sample sizes were small and evaluation for AEs was not performed in a systematic way, possibly resulting in a reduced event detection rate (20,23,26).…”

“…Despite this theoretical benefit, clinical trials evaluating the efficacy of erythromycin have demonstrated conflicting results. Sample size limitations, significant variability in timing of erythromycin initiation, either prophylactically or in response to clinical symptoms, and a wide range of recommended doses may explain the inconsistent results (16)(17)(18)(19)(20)(21)(22)(23). A double-blind, randomized controlled trial found benefit for 12 infants >32 weeks' gestation and no difference from placebo for 13 infants <32 weeks (16).…”