Erythromycin and feeding intolerance in premature infants: a randomized trial

Objectives: To evaluate the effectiveness of low-dose oral erythromycin to treat feeding intolerance in preterm infants. Design: This study was a prospective, double-blind, randomised, placebo-controlled trial on 60 premature infants suffering from feeding intolerance. Thirty infants were given oral erythromycin 1 mg/kg every 8 h and 30 infants were given placebo (normal saline). Randomization was stratified on enrollment according to gestational age whether >32 weeks of <= 32 weeks. The primary end point was the length of time taken to establish full enteral feeding since enrollment. Potential adverse effects associated with erythromycin were also monitored. Groups of each corresponding stratum were compared using two-tail t-test and Mann-Whitney for continuous variables, and chi(2) and Fisher's exact for categorical variables. Results: For infants with gestational age >32 weeks, the erythromycin group achieved full enteral feeding earlier than placebo group (10.5+/-4.1 vs 16.3+/-5.7 days, respectively; P = 0.01) had fewer episodes of gastric residuals (P < 0.05) and shorter duration of parenteral nutrition (PN) (P < 0.05). On the other hand, in infants with gestational age <= 32 weeks, there were no significant differences between erythromycin and placebo groups regarding any of these variables. Conclusions: Low-dose enteral erythromycin is associated with better tolerance of feeding and shorter duration of PN in infants >32 weeks gestation. A similar effect on younger preterm infants was not demonstrable.