Efficacy of prophylactic oral erythromycin to improve enteral feeding tolerance in preterm infants: a randomised controlled study

Mohammadizadeh M, Ghazinour M, Iranpour R
Correspondence: Dr Majid Mohammadizadeh, m_mohammadizadeh@med.mui.ac.ir

ABSTRACT
Introduction Enteral feeding intolerance is a major problem in preterm infants. This study evaluated the safety and efficacy of prophylactic low-dose oral erythromycin, a motilin agonist, as a prokinetic agent in reducing the incidence of this problem.
Methods From February to May 2008, a prospective randomised controlled trial was conducted at the Isfahan University of Medical Sciences, Isfahan, Iran. 70 uncomplicated preterm infants (28–34 weeks’ gestation) weighing 1,000–1,500 g were randomly assigned to either a case group receiving low-dose oral erythromycin (6 mg/kg/day, in four doses over ten days) or a control group (n is 35 in each group) until they were fully fed enterally (150 ml/kg/day). Gavage feeding of the mother’s milk was started within the first three days of life, and erythromycin was given simultaneously. The time taken to reach full enteral feeding and the total duration of feeding interruption due to intolerance were compared.
Results The time taken to reach full enteral feeding was significantly shorter in the erythromycin group than the control group (10.11 +/- 2.51 versus 12.71 +/- 5.76 days, p is 0.01). In the control group, the mean duration of feeding interruption was significantly longer (84.00 +/- 62.58 versus 32.57 +/- 11.93 hours, p is 0.005) and more episodes of abdominal distention and significant gastric residue were also noted (p less than 0.05). No infant in the erythromycin group developed cardiac arrhythmias or pyloric stenosis.
Conclusion The prophylactic use of erythromycin may be warranted in very low birth weight infants, provided the efficacy and safety of the drug can be confirmed in further studies.

Keywords: erythromycin, feeding intolerance, preterm infant
Singapore Med J 2010; 51(12): 952-956