Is metoclopramide safe for the premature infant?

BACKGROUND: Gastroesophageal reflux disease (GERD) may occur with poor weight gain, esophagitis, hematemesis and respiratory problems in an infant. Common treatment strategies include positioning, feeding thickeness, histamine2 receptor antagonists, antiacids, and prokinetics. Metoclopramide is a prokinetic drug used to treat GERD and it has been reported to be a most commonly prescribed medication in neonatal intensive care unit (NICU). This research involves a patient that was born at 30 weeks' gestation age and on the twentieth day of his admission, vomiting and gastric residuals were observed. All diseases which are related these symptoms were excluded. With no improvement observed following non-pharmacological interventions and metoclopramide was started with a dosage of 0.1 mg/kg, per dose 12 hours. After the second dose of metoclopramide, dystonic reactions occured. The premature infant was evaluated for differential diagnosis of the abnormal movements. No abnormal findings were reported. The dystonic reactions didn't recur after metoclopramide was stopped. CONCLUSIONS: The observed adverse effects of metoclopramide in the preterm infant might be due to an excessive serum concentration of the drug as a result of its prolonged plasma clearance in this age group. Attention is drawn to the serious adverse effects of metoclopramide in the neonate, particularly premature infant.

Total antioxidant capacity and total oxidant status in perinatal asphyxia in relation to neurological outcome.

This study aimed to investigate the global oxidant/antioxidant status of infants with perinatal asphyxia and its relation to neurological outcomes. A prospective controlled study including term infants with perinatal asphyxia was conducted. Blood samples were obtained from patients and controls at 6-24 h and on the 3rd day of life for TAC and TOS measurement and OSI values were calculated. Neurodevelopment was evaluated at 12 months of age in survivors using Bayley scales of infant development II (BSID II). 17 term infants with perinatal asphyxia and 17 healthy controls were enrolled. On the first day of life TAC, TOS and OSI were significantly higher in patients with perinatal asphyxia (p<0.001). Total antioxidant capacity decreased significantly on day 3 compared to first day of life in the patient group (p=0.04). Infants with seizures and abnormal amplitude-integrated electroencephalography recordings had higher TOS and OSI levels in the 1st day. There was no correlation between TAC, TOS and OSI levels and BSID II scores. In conclusion oxidant/antioxidant balance is disturbed in favour of oxidants in perinatal asphyxia. Degree of oxidative stress is related to severity of neurological involvement in the first days of life.