High-Dose Oral Erythromycin Decreased the Incidence of Parenteral Nutrition-Associated Cholestasis in Preterm Infants

Ng, Pak Cheung; Lee, Cheuk H.; Wong, Samuel S. Y.; Lam, Hugh Simon; Liu, Flora Y.B.; So, K. W.; Lee, Cheuk Y.; Fok, Tai-fai

doi:10.1053/j.gastro.2007.03.043

Cited by 67 publications

(72 citation statements)

References 69 publications

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“…None of our patients in the erythromycin group developed septicemia from antibiotic-resistant organisms. Infantile hypertrophic pyloric stenosis and life-threatening cardiac dysrhythmia have not been reported in previous clinical trials, 14,24,25 and we did not observe these in our patients. Our study demonstrated that erythromycin-treated infants had significantly fewer episodes of large residual gastric aspirates and were able to attain FEF more quickly, as noted in other.…”

Section: Discussioncontrasting

confidence: 65%

“…14 Significantly fewer erythromycin-treated patients had abnormally raised serum alanine aminotransferase. 14 In our study, when we examined GGT elevation before and after treatment, the increase was found to be higher than in the placebo group. For that reason, it can be concluded that in the prevention of IFALD, erythromycin is more effective than is placebo.…”

Section: Discussionmentioning

confidence: 45%

“…Per previous reports the erythromycin dose was 12.5 mg kg À1 . [12][13][14] UDCA was given at a dose of 5 mg kg À1 every 6 h. Placebo solution was given as an equivalent volume of normal saline.…”

Section: Methodsmentioning

confidence: 99%

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A controlled trial of erythromycin and UDCA in premature infants during parenteral nutrition in minimizing feeding intolerance and liver function abnormalities

et al. 2011

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Objective: To compare the effectiveness of oral erythromycin versus ursodeoxycholic acid (UDCA) treatment in preventing feeding intolerance and liver function abnormalities.Study Design: A prospective, double blind, randomized, controlled trial in which three groups of preterm infants (birth weight <1500 g) were randomized to erythromycin (12.5 mg kg À1 per day), UDCA (5 mg kg À1 every 6 h) or placebo treatment. During the period 352 infants were admitted to our unit of which 75 infants whose parents accepted participation were enrolled in the study. Full enteral feeding or intestinal failure-associated liver disease was considered as the primary outcome measures.Results: Time to achieve full feeding after beginning the treatment was significantly shorter in the erythromycin group (P ¼ 0.014). g-Glutamyl transpeptidase levels in the placebo group were significantly higher than in the intervention groups (P ¼ 0.001). GTT level was slightly lower in UDCA groups than erythromycin. Conclusion:Oral erythromycin was most effective in facilitating enteral feeding and UDCA was most effective in preventing cholestasis in very low birth weight infants. Prophylactic usage of UDCA could be considered in infants with prolonged parenteral nutrition.

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Section: Discussioncontrasting

confidence: 65%

Section: Discussionmentioning

confidence: 45%

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A controlled trial of erythromycin and UDCA in premature infants during parenteral nutrition in minimizing feeding intolerance and liver function abnormalities

et al. 2011

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“…These infants often remain dependent on parenteral nutrition (PN) for survival and growth. However, prolonged PN has been associated with serious complications, including nutritional deficiencies, risks secondary to central venous catheters and PN-associated cholestasis (PNAC) [1,2]. Neonatal PNAC is characterised by intrahepatic cholestasis and liver fibrosis and in severe cases can result in liver failure, with corresponding derangement in liver function, including raised plasma-conjugated bilirubin (CBil) and alanine aminotransferase (ALT) [3].…”

Section: Introductionmentioning

confidence: 99%

A Double-Blind Randomised Controlled Trial of Fish Oil-Based versus Soy-Based Lipid Preparations in the Treatment of Infants with Parenteral Nutrition-Associated Cholestasis

Lam

Tam²,

Poon³

et al. 2014

Neonatology

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Background: Infants receiving prolonged parenteral nutrition (PN) are at risk of PN-associated cholestasis (PNAC). This can progress to hepatic failure and death if PN cannot be discontinued. Fish oil-based parenteral lipid preparation (FOLP) has been shown to be beneficial in case studies. Objectives: (1) To evaluate whether FOLP could halt or reverse the progression of PNAC compared with soy-based parenteral lipid preparation (SLP) and (2) to assess the effects of FOLP on liver function and physical growth. Methods: Design: double-blind randomised controlled trial. Setting: level III neonatal intensive care unit. Participants: infants with PNAC (plasma-conjugated bilirubin concentration ≥34 µmol/l or 2 mg/dl) expected to be PN-dependent for >2 weeks. Intervention: to receive either FOLP or SLP at 1.5 g/kg/day. Primary outcome measure: reversal of PNAC within 4 months after commencement of lipid treatment; secondary outcomes: rate of change of weekly liver function tests, infant growth parameters, blood lipid profile and episodes of late-onset sepsis. Results: A total of 9 infants were randomised to the FOLP group and 7 to the SLP group. There was no significant difference in reversal of PNAC at 4 months between groups. Rates of increase of plasma-conjugated bilirubin and alanine aminotransferase in the SLP group were significantly greater than the FOLP group (13.5 vs. 0.6 µmol/l per week and 9.1 vs. 1.1 IU/l per week, respectively, p = 0.03). Increased enteral nutrition was associated with significant improvement of PNAC in infants receiving FOLP compared with SLP (-8.5 vs. -1.6 µmol/l per 10% increase in enteral nutrition, respectively). The study was terminated prematurely. Conclusions: progression of PNAC in PN-dependent infants can be halted by replacing SLP with FOLP and reversed by increasing the proportion of enteral nutrition in infants receiving FOLP. Replacement of SLP with FOLP in PN-dependent infants who develop PNAC may be considered.

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“…With regards to safety of erythromycin, we found no diarrhea, arrhythmia, or hypertrophic pyloric stenosis in the treatment group, similar to other studies. 16,19,20 Long-term erythromycin can change the normal intestinal flora, with high-dose or therapeutic doses leading to diarrhea and sepsis. 21,22 However, Ng found no intestinal microorganism changes after the use of erythromycin for 10 days and 4 weeks.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of oral erythromycin to enhance feeding tolerance in preterm infants

Sukmawati

Rohsiswatmo

Suradi

et al. 2017

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Background Feeding intolerance is a common condition that affects preterm infants. Erythromycin is a prokinetic agent used to treat feeding intolerance, but its efficacy remains inconclusive. Objective To evaluate the effectiveness of oral erythromycin to enhance feeding tolerance in preterm infants. Methods This prospective, randomized controlled trial in preterm infants was conducted at Sanglah Hospital, Denpasar, Bali, from June 2015 to January 2016. Eligible infants were randomized to receive either 12.5 mg/kg/dose oral erythromycin or a placebo, every 8 hours. The primary outcome was the time to establish full enteral feeding. The secondary outcomes were body weight at full enteral feeding and length of hospital stay. Results Of 62 initial subjects, 3 infants dropped out of the study. Thirty infants were given erythromycin and 29 infants were given placebo. The baseline characteristics of the two groups were similar, with mean of gestational ages of 31.4 (SD 1.7) weeks in the erythromycin group and 32.4 (SD 2.2) weeks in the placebo group. The median times to reach full enteral feeding did not significantly differ between the two groups, with 10 (SD 5.3) days in the erythromycin group vs. 8 (SD 6.5) days in the placebo group (P=0.345). Also, median body weights at full enteral feeding and lengths of hospital stay were not significantly different between the two groups. Conclusion Erythromycin of 12.5 mg/kg/dose every 8 hours as prophylactic treatment does not significantly enhance feeding tolerance in preterm infants. Median body weights at full enteral feeding and length of hospital stay are not significantly different between the erythromycin and placebo groups. [Paediatr Indones. 2017;57:154-9 doi: http://dx

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High-Dose Oral Erythromycin Decreased the Incidence of Parenteral Nutrition-Associated Cholestasis in Preterm Infants

Abstract: High-dose oral erythromycin can be considered as a rescue measure for VLBW infants who fail to establish adequate enteral nutrition and in whom anatomically obstructive pathologies of the gastrointestinal tract have been excluded.

Cited by 67 publications

References 69 publications

A controlled trial of erythromycin and UDCA in premature infants during parenteral nutrition in minimizing feeding intolerance and liver function abnormalities

A controlled trial of erythromycin and UDCA in premature infants during parenteral nutrition in minimizing feeding intolerance and liver function abnormalities

A Double-Blind Randomised Controlled Trial of Fish Oil-Based versus Soy-Based Lipid Preparations in the Treatment of Infants with Parenteral Nutrition-Associated Cholestasis

Efficacy of oral erythromycin to enhance feeding tolerance in preterm infants

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