Intravenous low-dose erythromycin administration for infants with feeding intolerance

Background: This study was undertaken to determine the efficacy of low-dose intravenous erythromycin (EM) administration in infants with feeding intolerance. Methods: The subjects were 26 infants who would not accept enteral feeding within 5 days after birth. Fourteen infants (gestational age: 30.6 ′ 5.4 weeks and birthweight: 1466 ′ 825 g) were given EM intravenously at a dose of 1 mg/kg, three times daily (EM group). Doses were increased to 2 mg/kg in five infants who showed a poor response. Twelve infants (gestational age: 30.5 ′ 5.0 weeks and birthweight: 1317 ′ 672 g) were observed without EM administration (non-EM group). Blood concentrations of EM at 2 h after administration were measured on 8 (′ 2) days after the start of EM administration in the EM group. Results: Digestive perturbations and intestinal gasless and/or atonic shadows on X-ray findings markedly improved in the EM group soon after the treatment. Comparing the EM group and non-EM group, the postnatal ages at the start of successful enteral feeding were 9.1 ′ 3.2 days and 14.0 ′ 4.1 days, respectively (P < 0.01). The postnatal ages at feeding of 100 mL/kg per day were 15.2 ′ 4.0 days and 23.4 ′ 6.2 days, respectively (P < 0.01). The blood EM concentrations of 1 mg/kg and 2 mg/kg were 0.29 ′ 0.28 μg/mL and 0.57 ′ 0.20 μg/mL, respectively (P < 0.05). No adverse effect on cardiac status or in blood examinations was observed in any infant in the EM group. Conclusion: These results suggest that intravenous low-dose EM administration is a useful and safe treatment of feeding intolerance in infants including extremely low-birthweight infants.