High-dose oral erythromycin decreased the incidence of parenteral nutrition-associated cholestasis in preterm infants.
OBJECTIVE
Feeding intolerance because of functional gastrointestinal dysmotility and parenteral nutrition-associated cholestasis (PNAC) are common problems in preterm, very-low-birth-weight (VLBW) infants. This double-blind, randomized, placebo-controlled study aimed to assess the effectiveness of "high-dose" oral erythromycin as a prokinetic agent in decreasing the incidence of PNAC. Two secondary end points, including the time to achieve full enteral feeding and the duration of parenteral nutrition, were also evaluated.


METHODS
Infants consecutively admitted to the neonatal unit were randomized to receive erythromycin (12.5 mg/kg/dose every 6 hours for 14 days) or an equivalent volume of normal saline (placebo) if they attained less than half the total daily fluid intake (<75 mL/kg/day) as milk feeds on day 14 of life.


RESULTS
Of 182 VLBW infants enrolled, 91 received erythromycin. The incidence of PNAC was significantly lower in erythromycin-treated infants (18/91) compared with placebo infants (37/91; P = .003). Treated infants achieved full enteral nutrition significantly earlier (mean, 10.1; SE, 1.7 days; P < .001), and the duration of parenteral nutrition was also significantly decreased by 10 days (P < .001). Importantly, fewer infants receiving erythromycin had 2 or more episodes of septicemia (n = 4) compared with placebo patients (n = 13, P = .03). No serious adverse effect was associated with erythromycin treatment.


CONCLUSIONS
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.
Ng
Pak C
PC
Department of Pediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. pakcheungng@cuhk.edu.hk
Lee
Cheuk H
CH
Wong
Samuel P S
SP
Lam
Hugh S
HS
Liu
Flora Y B
FY
So
King W
KW
Lee
Cheuk Y
CY
Fok
Tai F
TF
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002779:Cholestasis / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004750:Enteral Nutrition; D004917:Erythromycin / Q000008:administration & dosage*; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage*; D005769:Gastrointestinal Motility / Q000187:drug effects / Q000502:physiology; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000503:physiopathology / Q000517:prevention & control; D019102:Infant, Very Low Birth Weight / Q000502:physiology*; D008297:Male; D010288:Parenteral Nutrition / Q000009:adverse effects*; D018805:Sepsis / Q000517:prevention & control
D000900:Anti-Bacterial Agents; D005765:Gastrointestinal Agents; D004917:Erythromycin