High-dose oral erythromycin decreased the incidence of parenteral nutrition-associated cholestasis in preterm infants.

Abstract:

BACKGROUND & AIMS: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.

journal_name

Gastroenterology

journal_title

Gastroenterology

authors

Ng PC,Lee CH,Wong SP,Lam HS,Liu FY,So KW,Lee CY,Fok TF

doi

10.1053/j.gastro.2007.03.043

subject

Has Abstract

pub_date

2007-05-01 00:00:00

pages

1726-39

issue

5

eissn

0016-5085

issn

1528-0012

pii

S0016-5085(07)00567-7

journal_volume

132

pub_type

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