Efficacy comparison between oral erythromycin versus domperidone for the treatment of feeding intolerance in preterm neonates.

BACKGROUND: Domperidone and erythromycin are commonly used as prokinetic agents for feeding intolerance in preterm neonates; however, no data from a previous study have compared their efficacy. This study aimed to compare the efficacy of orally administered domperidone and erythromycin for the treatment of feeding intolerance in preterm infants. METHODS: This retrospective cohort study included preterm neonates with a birthweight of <1800 g and gestational age <37 weeks. Data were collected from medical records at Queen Sirikit National Institute of Child Health (QSNICH) from 2006 to 2014. The primary outcome was the time to establish full enteral feeding (150 ml/kg/day) after starting oral domperidone or erythromycin for the treatment of feeding intolerance in preterm neonates. The secondary outcome was adverse effects associated with domperidone and erythromycin therapy. RESULTS: Among the 150 preterm neonates enrolled in this study, 66 received domperidone, and 84 received erythromycin. The baseline characteristics and comorbidities were not significantly different between the two groups; however, the gestational age at birth of neonates in the domperidone group was significantly lower than that of those in the erythromycin group. The time to establish full enteral feeding did not differ between the domperidone (11 days, "IQR," [6, 17]) and erythromycin (10 days, IQR [7, 14]) groups (p = 0.622). No major adverse effects were noted. There were only three preterm infants who had elevated liver enzymes in each group, but the difference between groups was not significant. CONCLUSION: From this study, the efficacy of oral domperidone was promising equivalent to oral erythromycin and seems to be one of the treatment options for feeding intolerance in preterm neonates. However, large randomized, controlled trials are needed to confirm the efficacy and safety of domperidone in this population.

Treatment of Kawasaki disease using locally product intravenous immunoglobulin.

BACKGROUND: Kawasaki disease (KD) is an acute febrile illness of unknown origin. Several kinds of IVIG have been shown to be effective in the decrease of the incidence of coronary artery abnormalities (CAA) which is the most serious complication. Nowadays, the National Blood Centre, Thai Red Cross Society can manufacture IVIG from the plasma of Thai blood donors which is much cheaper than the imported intravenous immunoglobulin (IVIG's). The effectiveness of this Thai Red-Cross IVIG in Kawasaki disease has never been documented. OBJECTIVE: To determine the initial treatment response and prevalence of CAA in KD treated with a high dose (2 g/kg) of Thai Red-Cross IVIG. PATIENTS AND METHOD: All patients with a diagnosis of KD who had initial treatment with 2 g/kg of Thai Red-Cross IVIG at Queen Sirikit National Institute of Child Health from December 2001 to February 2003 were reviewed retrospectively. RESULTS: All 22 cases (100%) had good response to a single treatment with a high dose of IVIG. The only patient who did not complete the IVIG treatment had a severe reaction following the administration of the drug and needed discontinuation and intervention. During the convalescent phase, there were only 2 cases (9.09%) with CAA in the first month and 1 case (4.55%) at the 3-month follow-up. This only case with CAA at 3 months had multiple aneurysms at the left main and left anterior descending coronary arteries. No giant aneurysms were found in the present study. CONCLUSION: The efficacy of a high dose (2 g/kg) of Thai Red-Cross IVIG in Kawasaki disease is excellent. However, the severe reaction in one patient needs further surveillance.