A placebo-controlled trial of low-dose erythromycin to promote feed tolerance in preterm infants

The aim of this study was to assess the efficacy of erythromycin. a motilin agonist, in promoting enteral feed tolerance in preterm infants of less th an or equal to 32 wk gestation. Eligible infants were randomized to receive either low-dose (2.5 mg kg(-1) per dose 6 hourly) oral erythromycin ethyls uccinate or placebo for 10 d from the time of the first oral reed, The data from 22 erythromycin and 21 placebo infants were analysed. Birthweights (e rythromycin 1216 +/- 380 g, placebo 1355 +/- 228 g, p = 0.25), gestation (e rythromycin 28.6 +/- 2.2 wk, placebo 29.3 +/- 1.7 wk, p = 0.24) and other c linical variables were not different between the groups. Almost all infants were fed expressed breast milk. Erythromycin infants had significantly few er episodes of large residual gastric aspirates (>30% of the previous 6 h w orth of feeds) over 10 d (erythromycin 1.1 +/- 1.9, placebo 3.6 +/- 2.2 epi sodes, p = 0.0007). Infants in the erythromycin group achieved full oral re eds more quickly (6.0 +/- 2.3 vs 7.9 +/- 3.5 d, P = 0.04). There were no si gnificant differences between the groups with regard to the number of days oil total parenteral nutrition or to the time needed to regain birthweight. One enrolled infant from each group died of necrotizing enterocolitis, Conclusion: Low-dose erythromycin promoted gastric emptying and feed tolera nce in premature infants at a lower gestational age than previously reporte d. Increased exposure to broad-spectrum antibiotics may not be free of risk . Further studies are recommended to assess its efficacy in premature infan ts with established feed intolerance.