Cisapride May Improve Feeding Tolerance of Preterm Infants: A Randomized Placebo-Controlled Trial

Abstract

To evaluate the efficacy of cisapride in improving tolerance of enteral feeding, 59 premature infants were randomized into a blinded placebo-controlled study. Treatment was initiated with the introduction of enteral feeding and continued until 150 ml/kg/day of milk were tolerated. Only in extremely low birth weight (ELBW) infants, was the time to tolerate full enteral feeding shorter in the treatment group, whereas ECG recordings showed a significantly prolonged QTc interval during treatment. Two children developed cardiac rhythm disturbances. In conclusion premature infants may not benefit from routine use of the drug to improve enteral feeding, and seem to be more vulnerable to its side effects.

Randomized Controlled Trial of Slow vs Rapid Enteral Feeding Advancements on the Clinical Outcomes of Preterm Infants With Birth Weight 750–1250 g

“…The role of prokinetic agents, including metoclopramide, domperidone, erythromycin, and cisapride, in preterm infants has been recently investigated in a number of randomized controlled trials 21 – 24 . Prokinetic agents that can enhance gastrointestinal (GI) motility may be potentially beneficial to ELBW infants who fail to establish full enteral feeding after a prolonged period and in whom a structural lesion of the GI tract has been excluded, by promoting milk feeding and reducing the duration of PN and its associated adverse effects.…”

Childhood gastroparesis is a unique entity in need of further investigation

“… RC, PC, vs cisapride—domperidone superior to cisapride in improving symptoms and accelerating gastric emptying (2002) RC, PC—improved feeds only in extremely low birth weight infants, but significant QTc prolongation (2005) RC, PC, XO—no difference (2001) RC, DB, PC—no difference (2000) RC, DB, PC—no difference (2000) RC, DB, PC—delayed gastric emptying (1999) RC, DB, PC—no difference (1998) …”

Medical management of motility disorders in patients with intestinal failure: a focus on necrotizing enterocolitis, gastroschisis, and intestinal atresia

“…Despite its reputation as a potent GIT prokinetic, a meta-analysis suggested an overall positive but modest treatment effect [42]. The greatest pitfall in the application of cisapride is the unpredictable occurrence of cardiac arrhythmias and sudden death [43]. The largest randomized trial to date of cisapride for intestinal dysmotility was stopped early because of the incidence of cardiac events [43].…”

“…The greatest pitfall in the application of cisapride is the unpredictable occurrence of cardiac arrhythmias and sudden death [43]. The largest randomized trial to date of cisapride for intestinal dysmotility was stopped early because of the incidence of cardiac events [43]. These effects are unrelated to the serotonin 4 effect but appear to be related to the benzamide structure of cisapride that blocks cardiac human ether-a-go-go-related gene potassium channels and can result in prolongation of the QT interval [6].…”

“…The available data are derived from a meta-analysis of randomized trials [42] (level Ia, class A), 2 randomized controlled trials [41,43] (level Ib, grade A), and 2 bench research studies (level V, class D).…”