Erythromycin treatment for gastrointestinal dysmotility in preterm infants

Abstract

As prolonged total parenteral nutrition carries significant risk of complications, this therapy could be considered in selected preterm infants who fail to establish enteral feeding after an extended period, and in whom an anatomically obstructive lesion of the gastrointestinal tract has been excluded. Meanwhile, we would caution against the widespread implementation of this therapeutic approach until formal evaluation by randomized controlled trials have established the exact role of erythromycin, or its analogues, in the treatment of intestinal dysmotility in preterm infants.

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

“…Its motilin agonistic action has also been clinically exploited for the management of a variety of GI dysmotility disorders, including: gastro-esophageal reflux, chronic functional pseudo-obstruction and postoperative intestinal ileus [9] . Further, erythromycin has been used successfully in facilitating transpyloric passage of endoscopes, Watson's capsules and nasoenteric feeding tubes into the proximal small bowel [9] .…”

“…Erythromycin, a commonly used macrolide and antibiotic, has been found to possess potent prokinetic properties and has been used in older children and adults for treatment of gastroparesis due to diabetes mellitus, scleroderma or following esophagectomy and vagotomy [9] . Its motilin agonistic action has also been clinically exploited for the management of a variety of GI dysmotility disorders, including: gastro-esophageal reflux, chronic functional pseudo-obstruction and postoperative intestinal ileus [9] .…”

“…Although GI dysmotility of prematurity per se is a relatively benign condition, the fear of NEC and other sinister intra-abdominal patholo- gies frequently results in stoppage of feeding and prolonged hyperalimentation. Long-term parenteral nutrition has been associated with increased risks of serious morbidity and sometimes even life-threatening complications, including parenteral nutrition-associated cholestasis (PNAC) [1,2] , recurrent catheter-related septicemia [7,8] , nutritional deficiency, biochemical rickets, and pain and anesthetic risks associated with repeated percutaneous and central long line insertions [9] . Thus, prokinetic agents that can enhance GI motility may be potentially beneficial to preterm 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 parenteral nutrition and its associated adverse effects.…”

Effect of Low-Dose Oral Erythromycin on Gastric Aspirates in Ventilated Neonates Less than 32 Weeks of Gestation

“…Previous randomised controlled trials using antimicrobial doses (12 mg/kg/6-8-hourly) of erythromycin have failed to demonstrate a beneficial effect on the establishment of full feeds in preterm neonates [7][8][9]. On the other hand in a small study [10] again using antimicrobial doses, a beneficial effect on gastrointestinal dysmotility was observed in 7 preterm infants. In another study [10], a loading dose of erythromycin was administered followed by doses similar to the one we used (3-5 mg/kg/day) gastrointestinal motility improved in 4 extremely low birth weight infants, while in a fifth infant improvement was observed without administering the loading dose.…”

“…On the other hand in a small study [10] again using antimicrobial doses, a beneficial effect on gastrointestinal dysmotility was observed in 7 preterm infants. In another study [10], a loading dose of erythromycin was administered followed by doses similar to the one we used (3-5 mg/kg/day) gastrointestinal motility improved in 4 extremely low birth weight infants, while in a fifth infant improvement was observed without administering the loading dose. Finally, in a recently published randomised controlled trial [12], oral erythromycin was administered to very low birthweight neonates with intestinal dysmotility using a dosed of 12 mg/kg/6-hourly.…”