Erythromycin for feeding intolerance in preterm infants

Ng, Eugene; Shah, Vibhuti

doi:10.1002/14651858.cd001815

Cited by 13 publications

(11 citation statements)

References 19 publications

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“…The glycerine suppositories, prokinetics, small volume enemas, (e.g. 5 ml/kg of a 9 1 1 mixture of 5% glucose and glycerine), and gastrograffin upper gastrointestinal series for evacuating meconium, meconium plugs is not uncommon in preterm neonates (10)(11)(12)(13)(14)(15)(16)(17). A recent survey of enteral feeding practices for neonates <32 weeks' gestation reported that glycerine suppositories and prokinetics were prescribed ('sometimes', 'often' and 'always') by (30.9, 9.1 and 3.6%), and (25.9, 5.6 and 0%) of the neonatologists, respectively (18).…”

Section: Discussionmentioning

confidence: 99%

“…Mihatsch et al (20) have evaluated the correlation between the timings of the first and the last stool and feeding intolerance in extremely low birth weight (ELBW) neonates. Forty-one ELBW neonates were fed following a standardised protocol (days [3][4][5][6][7][8][9][10][11][12][13][14]. Bolus gavage feeds were started at 48 h of age (12 mg/kg/day increments, 12 feeds a day).…”

Section: Discussionmentioning

confidence: 99%

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Does carboxymethylcellulose have a role in reducing time to full enteral feeds in preterm neonates?

Patole

Müller

2004

International Journal of Clinical Practice

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The efficacy of prophylactic carboxymethylcellulose (CMC) in reducing the time to reach full enteral feeds (FEFs) in neonates <32 weeks' gestation was studied in a clinical trial. When ready for feeds, enrolled neonates were allocated to either CMC (dose: CMC content of 12 mg oral erythromycin ethyl succinate syrup, 6 hourly) or placebo till either maximum 10 days treatment or FEF (150 ml/kg/day) was reached. A standardised regimen guided enteral feeding. Demographic characteristics of enrolled neonates (CMC, placebo: n = 35) were comparable. Median (interquartile range) gestational age and birth weight were 29 (28, 30) vs. 29 (27, 31) weeks and 1090 (905, 1390) vs. 1236 g (928, 1565) for the CMC and placebo groups, respectively. Median (interquartile range) time to reach FEF was 5 (4, 6) vs. 5 (3, 8) days for CMC and placebo group, respectively (p = 0.5). No CMC-related adverse effects occurred. Prophylactic CMC did not have a significant role in reducing time to reach FEF.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Does carboxymethylcellulose have a role in reducing time to full enteral feeds in preterm neonates?

Patole

Müller

2004

International Journal of Clinical Practice

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“…The characteristics of the study populations and findings of these RCTs are summarized in tables 1 and 2 . The 2 RCTs reported by The Cochrane Database of Systemic Review [20] are included in the current analysis.…”

Section: Review Of Rctsmentioning

confidence: 99%

Use of Oral Erythromycin for the Treatment of Gastrointestinal Dysmotility in Preterm Infants

2008

Neonatology

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Milk intolerance due to functional gastrointestinal (GI) dysmotility is a common problem in preterm infants. In the past decade, erythromycin has been used for its motilinomimetric effect to facilitate enteral feeding in preterm infants. Although earlier studies suggested that erythromycin is an effective prokinetic agent, recent randomized control trials (RCTs) reveal conflicting findings. This review assesses the evidence from all RCTs performed to date on erythromycin for preterm infants. The results suggest that oral erythromycin administered in intermediate or high doses as a rescue treatment is associated with a shorter time to attain full enteral feeding and decrease in the duration of requirement for parenteral nutrition. More importantly, the outcome study further indicates that oral erythromycin can reduce the incidence of parenteral nutrition-associated cholestasis by almost 50% and decreases the incidence of recurrent septicemia. None of the RCTs reported any sinister adverse effects, in particular, hypertrophic infantile pyloric stenosis or fatal cardiac arrhythmia. Nonetheless, as long-term outcomes have not been fully evaluated, neonatologists should use this treatment cautiously and selectively in preterm infants with moderately severe GI dysmotility.

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“…[17][18][19][20] An earlier systematic review that focused only on the use of low dose erythromycin (3-12 mg/kg/day) in preterm neonates (36 weeks gestational age with feeding tolerance did not find any eligible studies at the time. 21 The lack of a clear understanding of the basis of its prokinetic action, however, has recently resulted in a plethora of clinical trials using different doses, routes and modes of administration, and durations of treatment. Most of these trials used surrogate markers of gastrointestinal motility such as gastric residuals and time to FEFs to assess the efficacy of erythromycin as a prokinetic agent.…”

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confidence: 99%