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Erythromycin establishes early oral feeding in neonates operated for congenital intestinal atresias

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Abstract

Purpose

The recovery of gastrointestinal function following surgery for congenital intestinal atresias can be prolonged and may increase morbidity and hospital stay. This study was conducted to investigate the prokinetic effect of erythromycin in neonates undergoing surgery for small bowel atresias.

Methods

A randomized-controlled trial was conducted at the Departments of Paediatrics and Paediatric Surgery, Military Hospital, Rawalpindi, Pakistan, from January to December 2007 to study the prokinetic effect of erythromycin (3 mg/kg per dose 4 times daily). Thirty consecutive neonates undergoing primary anastomosis for congenital small bowel atresias were randomly divided into two groups: group I (erythromycin) and group II (control). The groups were similar in terms of gestational age, sex, mode of delivery, birth weight and types of atresias. Postoperative recovery of intestinal functions was measured as time taken to achieve full enteral feed (150 ml/kg per 24 h), duration of total parenteral nutrition (TPN) and hospital stay.

Results

Neonates receiving oral erythromycin achieved full enteral feeding early (13.07 vs. 16.13 days) required TPN for shorter duration (10.53 vs. 13.73 days) and their hospital stay was less (16.2 vs. 18.0 days) as compared to the neonates in the control group who did not receive any erythromycin. The differences were statistically significant.

Conclusion

The administration of oral erythromycin following primary anastomosis for small intestinal atresias results in early recovery of intestinal function, fewer days on TPN and a trend for shorter hospital stay.

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References

  1. Taeusch HW, Ballard RB, Gleason CA (eds) (2005) Avery’s diseases of newborn, 8th edn. Philadelphia, Elsevier, p 1095

    Google Scholar 

  2. Ozturk H, Ozturk H, Gedik S, Duran H, Ohen A (2007) A comprehensive analysis of 51 neonates with congenital intestinal atresia. Saudi Med J 28:1050–1054

    PubMed  Google Scholar 

  3. Khen N, Jaubert F, Sauvat V, Fourcade F, Jan D, Martinovic J et al (2004) Fetal intestinal obstruction induces alteration of enteric nervous system development in human intestinal atresia. Pediatr Res 56:975–980

    Article  PubMed  Google Scholar 

  4. Curry JI, Lander TD, Stringer MD (2001) Erythromycin as a prokinetic agent in infants and children. Aliment Pharmacol Ther 15:595–603

    Article  PubMed  CAS  Google Scholar 

  5. Sekteera W, Nuntnarumit P, Supapannachart S (2002) Oral erythromycin for treatment of feeding intolerance in preterm infants: a preliminary report. J Med Assoc Thai 85:1177–1182

    Google Scholar 

  6. Ng PC, So KW, Fung KS, Lee CH, Fok TF, Wang E (2001) Study of oral erythromycin for treatment of gastrointestinal dysmotility in preterm infants. Arch Dis Child Fetal Neonatal Ed 84:177–182

    Article  Google Scholar 

  7. Ng PC, Fok TF, Lee CH, Wong W, Cheung KL (1997) Erythromycin treatment for gastrointestinal dysmotility in preterm infants. J Paediatr Child Health 33:148–150

    Article  PubMed  CAS  Google Scholar 

  8. Simkiss DE, Adams IP, Myrdal U, Booth IW (1994) Erythromycin in neonatal post-operative intestinal dysmotility. Arch Dis Child 71:F128–F129

    Article  PubMed  CAS  Google Scholar 

  9. Leung WK, Chaw FK, Fung SS, Wong MY, Sung JJ (2005) Effects of oral erythromycin on gastric and small bowel transit time of capsule endoscopy. World J Gastroenterol 11:4865–4868

    PubMed  CAS  Google Scholar 

  10. Koenig JB, Cote N, La Marre J, Harris WH, Trout DR, Kenny DG et al (2002) Binding of radiolabeled lactobionate to smooth muscle membranes in various segments of the equine gastrointestinal tract. Am J Vet Res 63:1545–1550

    Article  PubMed  CAS  Google Scholar 

  11. Weber FH Jr, Richards RD, McCallum RW (1993) Erythromycin: a motilin agonist and gastrointestinal prokinetic agent. Am J Gastroenterol 88:485–490

    PubMed  CAS  Google Scholar 

  12. Koenig JB, Sawhney S, Cote N, Lo Marre J (2006) Effect of intraluminal distension or ischaemic strangulation obstruction of the equire jejunum on jejunal motilin receptors and binding of erythromycin lactobionate. Am J Vet Res 67:815–820

    Article  PubMed  CAS  Google Scholar 

  13. Curry JI, Lander AD, Stringer MD (2004) BAPS multicentre research committee. A multicenter randomized, double-blind, placebo-controlled trial of the prokinetic agent erythromycin in the postoperative recovery of infants with gastroschisis. J Pediatr Surg 39:565–569

    Article  PubMed  CAS  Google Scholar 

  14. Kaul A (2002) Erythromycin as a prokinetic agent. J Pediatr Gastoenterol Nutr 34:13–15

    Article  CAS  Google Scholar 

  15. Jadcherla SR, Klee G, Berselh CL (1997) Regulation of migratory motor complexes by motilin and pancreatic polypeptide in human infants. Peadiatr Res 42:365–369

    Article  CAS  Google Scholar 

  16. Jadcherla SR, Berselh CL (2002) Effect of erythromycin on gastroduodenal contractile activity in developing neonates. J Pediatr Gastroenterol Nutr 34:16–22

    Article  PubMed  CAS  Google Scholar 

  17. Ng PC, Lee CH, Wong SP, Lom HS, Liu FY, So KW et al (2007) High-dose oral erythromycin decreased the incidence of parenteral nutrition-associated cholestasis in preterm infants. Gastoenterology 132:1726–1739

    Article  CAS  Google Scholar 

  18. Abrahmsson H (2007) Severe gastropaeresis: new treatment alternatives. Best Pract Res Clin Gastroenterol 21:645–655

    Article  Google Scholar 

  19. Panganamamula KV, Parkman HP (2005) Chronic intestinal pseudo-obstruction. Curr Treat Options Gastroenterol 8:3–11

    Article  PubMed  Google Scholar 

  20. Maclaren R, Kiser TH, Fish DN, Wischmeyer PE (2008) Erythromycin vs. metoclopramide for facilitating gastric emptying and tolerance to intragastric nutrition in critically ill patients. J Parenter Enteral Nutr 32:412–419

    Article  CAS  Google Scholar 

  21. Ohwada S, Satoh Y, Kawate S, Yamaoda T, Kawamura O, Kayama T et al (2001) Low dose erythromycin reduces delayed gastric emptying and improves gastric motility after Billroth I Pylorus-preserving pancreatico-duodenectomy. Ann Surg 234:668–674

    Article  PubMed  CAS  Google Scholar 

  22. Matsunaga H, Tanala M, Takahata S, Ogawa Y, Narilums G, Yokohata K et al (2000) Manometric evidence of improved early gastric stasis by erythromycin after pylorus-preserving pancreatico-duodenectomy. World J Surg 24:1236–1241

    Article  PubMed  CAS  Google Scholar 

  23. Roussel AJ, Hooper RN, Cohen ND, Bye AD, Hicks RJ, Bohl TW (2000) Prokinetic effects of erythromycin on the ileum, caecum and pelvic flexure of horses during the postoperative period. Am J Vet Res 61:420–424

    Article  PubMed  CAS  Google Scholar 

  24. Lightfoot AJ, Eno M, Kreder KJ, O’Donnell MA, Rao SS, William RD (2007) Treatment of postoperative ileus after bowel surgery with low-dose intravenous erythromycin. Urology 69:611–615

    Article  PubMed  Google Scholar 

  25. Smith AJ, Nissan A, Lanoutte NM, Shi N, Guillen JG, Wong WD et al (2000) Prokinetic effects of erythromycin after colorectal surgery: randomized, placebo-controlled, double-blind study. Dis Colon Rectum 43:333–337

    Article  PubMed  CAS  Google Scholar 

  26. Ozaki K, Sudo H, Muramatsu H, Yogo K, Kamel K, Koga H et al (2007) Mitemcinal(GM-611), an orally active motilin receptor agonist, accelerates colonic motility and bowel movements in conscious dog. Inflammopharmacology 15:36–42

    Article  PubMed  CAS  Google Scholar 

  27. Ozaki K, Monnai M, Onoma M, Muramatsu H, Yogo K, Watnabe T et al (2008) Effects of mitemcinal (GM-611), an orally active erythromycin-derived prokinetic agent, on delayed gastric emptying and postprandial glucose in a new minipig model of diabetes. J Diabetes Complications 22:339–347

    Article  PubMed  Google Scholar 

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Correspondence to C. Aqeel Safdar.

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Razzaq, A., Safdar, C.A. & Ali, S. Erythromycin establishes early oral feeding in neonates operated for congenital intestinal atresias. Pediatr Surg Int 25, 361–364 (2009). https://doi.org/10.1007/s00383-009-2347-5

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  • DOI: https://doi.org/10.1007/s00383-009-2347-5

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