Efficacy of high-dose oral erythromycin on enhancement of feeding tolerance in premature neonates

Objective: Most   neonates admitted to neonatal wards do not tolerate sufficient milk.  Recently the effect of erythromycin on increasing feeding tolerance in neonates has been studied. In this study the effectiveness of oral, high dose Erythromycin a prokinetic agent was used to enhance feeding tolerance in these neonates.  Methods: This prospective randomized controlled clinical trial was conducted on 60 premature neonates with birth weight< 1800 g at Hafez and Namazi hospitals in Shiraz during a 13- month period. Those neonates who did not tolerate milk more than 75 cc/kg/day five days after starting feeding, were chosen for the study. A total of 60 neonates were studied who were divided randomly into two equal groups (control and study), and were  similar in  sex, birth weight, gestational age, apgar score, route of delivery, oxygen need, type of milk and corticosteroid therapy in the antepartum period. Oral erythromycin (ethyl succinate suspension) was given in a dose of 12.5mg/kg/dose every 6 hours for a maximum of 10 days, or until they tolerated full enteral feeding (150 cc/kg/day). One neonate in the erythromycin group and two neonates in the control group expired during the study. Results: Oral erythromycin was effective on enhancement of feeding tolerance in premature neonates with gestational age equal to or more than 32 weeks (p= 0.031) and lead to earlier discharge of these neonates from hospital (p= 0.003). Also oral erythromycin was relatively effective in enhancement of feeding and early discharge of neonates with birth weight equal to or greater than 1500 g. Erythromycin was not  effective for neonates less than 32 weeks of  age (very preterm). In this study,  no adverse effects (necrotizing enterocolitis, sepsis, O2 dependency, patent ductus arteriosus, high-dose positive stool culture or prolonged QT interval) were observed following erythromycin usage. Conclusion: High-dose oral erythromycin in premature neonates of gestational age equal to or greater than 32 weeks with feeding intolerance is effective for increasing feeding tolerance and earlier hospital discharge. However, routine use   is not suggested.