Erythromycin and Reflux Events in Premature Neonates

Objective: Gastroesophageal reflux disease (GERD) in premature neonates may manifest as apnea, bradycardia, growth failure, aspiration, or feeding intolerance. Erythromycin ethylsuccinate (EES), is often used as a pro‐kinetic in the management of GERD, despite lack of evidence or safety from randomized controlled trials. We sought to study the efficacy of enteral EES at a dose of 50 mg · kg −1 · day −1 in decreasing the frequency of gastroesophageal reflux events as determined by pH‐multichannel intraluminal impedance (pH‐MII) monitoring. Methods: In a randomized, double‐blind, placebo‐controlled trial, eligible premature neonates with clinical signs of GERD underwent 24‐hour pH‐MII monitoring. If >5 reflux events were identified on pH‐MII, then subjects were randomized to receive either EES or placebo. Repeat 24‐hour pH‐MII was performed on day 7 of study treatment and compared to initial pH‐MII. Results: Forty‐three premature neonates were enrolled. Of those, 31 neonates were randomized, 15 to EES and 16 to placebo with a median (IQR) pretreatment total reflux events per 24 hours of 23 (16–40) and 29 (12–40), respectively. Day 7 total events per 24 hours decreased by 4 events in the EES group to 19 (15–33) and by 10 events in the placebo group to 19 (11–26) ( P = 0.09). There were no differences in pretreatment and day 7 acidic and nonacidic reflux, proximal reflux, total or percent reflux time, median or longest bolus clearance time, or nurse‐reported apnea events between groups. Conclusions: Enteral EES did not decrease reflux events on 24‐hour pH‐MII at the dose studied. Therefore, it may be ineffective in the treatment of GERD in premature neonates.