Materials and methods Three groups of preterm infants (birth weight ≤1500 g) who received less than half of the total daily fluid intake and parenteral nutrition for more than two weeks were randomized to either erythromycin (12.5 mg/kg every 6 h) or placebo solution or ursodeoxycholic acid (5 mg/kg every 6 h) treatment. Liver function abnormality was considered as the primary outcome measure. Secondary outcomes were full enteral feeding, number of episodes of gastric residuals, duration of total parenteral nutrition and days of hospitalisation.
full feeding and number of episodes of gastric residuals were considered as the primary outcome measures. Results All clinical features were comparable between two groups. Time to achieve full feeding after beginning the treatment was similar between the two groups. The number of periods that feeding was withheld because of gastric residuals was significantly higher in the placebo group than in the clarithromycin group (p < 0.05).
Results Conclusions All clinical features except birth weight [erythromycin: 1152 ± 182 g, ursodeoxycholic acid: 1038 ± 221 g, placebo: 975 ± 200 g; p = 0.011] and gestational age [erythromycin: 28.5 (26–32), ursodeoxycholic acid: 28 (24–32), placebo: 27 (25–30); p = 0.006] were comparable between three groups. Erythromycin and ursodeoxycholic acid treated infants had higher gestational age and birth weight than placebo group. Time to achieve full feeding after beginning the treatment was significantly shorter in erythromycin group than placebo. When comparisons were further evaluated by statistical methods with covariates including gestational age the results were also found similar. There was no significant difference between ursodeoxycholic acid and erythromycin groups. Conclusions Our study shows that, oral erythromycin is the most effective one in facilitating enteral feeding and ursodeoxycholic acid is the most effective in preventing cholestasis in VLBW infants. Although our findings suggest that erythromycin treatment is effective in reaching full enteral feeding earlier, the sample size may still be inadequate to detect subtle adverse effects or outcomes in the long term.
PP-166. Is clarithromycin treatment effective in facilitating enteral feeding in VLBW infants? Tulin Gokmen, Ramazan Ozdemir, Senol Bozdag, Serife Suna Oguz, Omer Erdeve, Nurdan Uras, Ugur Dilmen Zekai Tahir Burak Maternity Teaching Hospital Neonatal Intensive Care Unit, Turkey Aim Clarithromycin is a semisynthetic macrolide antibiotic, which is more acid stable than other macrolides like erythromycin, and is rapidly absorbed after oral administration. Motilin receptor stimulation with erythromycin has been shown to have a prokinetic effect on enteral feeding in VLBW infants. Our aim was to find out whether oral clarithromycin has similar prokinetic activity. Materials and methods A prospective randomised trial was conducted to evaluate the efficacy of oral clarithromycin in preventing feeding intolerance of preterm infants. A total of thirty five preterm infants with birth weight <1500 g and <32 weeks gestation were enrolled in the study. Oral clarithromycin or placebo was commenced in the first week of life for ten days. Antimicrobial dose of oral clarithromycin (15 mg/kg/ day) was given to seventeen of these preterm infants. Time to achieve
Our study indicates that clarithromycin treatment is effective in decreasing the number of episodes of gastric residuals. Although time to achieve full enteral feeding is not significantly different between the two groups, we believe that the largest randomised controlled studies are required for showing the prokinetic effect of clarithromycin. doi:10.1016/j.earlhumdev.2010.09.221
PP-167. Total parenteral nutrition associated complications in NICU patients Sumer Sutcuoglu, Aydın Erdemir, Pelin Kosker, Esra Arun Ozer, Zelal Kahramaner, Ebru Turkoglu, Hese Cosar, Ali Kanık Department of Neonatology, Tepecik Training and Research Hospital, Izmir, Turkey Aim The aim of the study is to determine the complications related to total parenteral nutrition (TPN) and risk factors in neonates. Materials and methods A total of 294 neonates administered TPN more than 24 h in neonatal intense care unit were evaluated retrospectively. Results The complications related to TPN were sepsis, cholestasis, hyperlipidemia, thrombocytopenia, pancytopenia, electrolyte imbalances and hepatic dysfunction. In 96 out of 294 cases in the study group, some complications dependent on TPN were determined. The most frequent complication was sepsis with the ratio of 21%. The general characteristics, diets and clinical features of the neonates that have complications associated with TPN and that have no complications concerning TPN were compared statistically. We observed that the birth weights, heights and the circumference of heads were statistically smaller in neonates that have TPN related complications (p = 0.01, 0.009 and 0.007, respectively). Conclusions It was considered that TPN led to complications in neonates especially to those who have low weight and who have no toleration for enteral feedings. Furthermore, to prevent these complications, it was noted that it is important to initiate early enteral feedings in these neonates. doi:10.1016/j.earlhumdev.2010.09.222