Efficacy of erythromycin for postpyloric placement of feeding tubes in critically ill children: A randomized, double-blind, placebo controlled study

Background: Erythromycin enhances gastric emptying and has been suggested t o facilitate nasoenteric feeding tube placement in adults. Our primary obje ctive was to evaluate the effect of erythromycin on the transpyloric passag e of feeding tubes in critically ill children, and second, to evaluate the effect of erythromycin on the distal migration of duodenal feeding tubes. M ethods: Seventy-four children were randomly assigned to receive erythromyci n lactobionate (10 mg/kg) IV or equal volume of saline placebo 60 minutes b efore passage of a flexible weighted tip feeding tube. Abdominal radiograph s were obtained 4 hours later to assess tube placement. If the tube was pro ximal to the third part of the duodenum, two additional doses of erythromyc in/placebo were administered 6 hours apart. Those receiving additional dose s had repeat radiographs 14 to 18 hours after tube placement. Results: The number of postpyloric feeding tubes was similar in the erythromycin and pla cebo treated groups 4 hours after tube insertion (23/37 us 27/37, p = .5). Of those with prepyloric tubes at 4 hours, none in the erythromycin group a nd 3 in the placebo group had the tube migrate to the postpyloric position by 14 to 18 hours (p < .05). Of those with postpyloric tubes proximal to th e third part of the duodenum at 4 hours, additional doses of erythromycin d id not cause more tubes to advance further into the intestine than did plac ebo (p = .6). Conclusions: Erythromycin does not facilitate transpyloric pa ssage of feeding tubes in critically ill children. The distal migration of duodenal tubes further into the small bowel is also not enhanced by erythro mycin.