Efficacy of intermediate-dose oral erythromycin on very low birth weight infants with feeding intolerance

Background: Erythromycin is generally used as a prokinetic agent for the treatment of feeding intolerance in preterm infants; however, results from previous studies significantly vary due to different medication dosages, routes of administration, and therapy durations. The effectiveness and safety of intermediate-dose oral erythromycin in very low birth weight (VLBW) infants with feeding intolerance was examined in this study. Methods: Between November 2007 and August 2009, 45 VLBW infants with feeding intolerance, who were all at least 14 days old, were randomly allocated to a treatment group and administered 5 mg/kg oral erythromycin every 6 hours for 14 days (n = 19). Another set of randomly selected infants was allocated to the control group, which was not administered erythromycin (n = 26). Results: The number of days required to achieve full enteral feeding (36.5 ± 7.4 vs. 54.7 ± 23.3 days, respectively; p = 0.01), the duration of parenteral nutrition (p < 0.05), and the time required to achieve a body weight ≥2500 g (p < 0.05) were significantly shorter in the erythromycin group compared with the control group. The incidence of parenteral nutrition-associated cholestasis (PNAC) and necrotizing enterocolitis (NEC) ≥ stage II after 14 days of treatment were significantly lower (p < 0.05) in the erythromycin group. No significant differences were observed in terms of the incidences of sepsis, bronchopulmonary dysplasia, or retinopathy of prematurity. No adverse effects were associated with erythromycin treatment. Conclusions: Intermediate-dose oral erythromycin is effective and safe for the treatment of feeding intolerance in VLBW infants. The incidences of PNAC and ≥ stage II NEC were significant lower in the erythromycin group.