Low-dose erythromycin treatment was applied to 36 cases of neonatal vomiting. Among them, 18 cases weighed ~3kg, 22 cases weighed between 3kg to 4kg, and 8 cases were ≥4kg. Underlying diseases included: 18 cases of asphyxia, 14 cases of premature infants under foster care, 28 cases of vomiting of unknown origin, 6 cases of full-term small for gestational age, and 2 cases of respiratory failure. The 68 cases were randomly divided into: treatment group with 36 cases, and control group with 32 cases. Age, gender, weight, and condition were comparable between the two groups. On the basis of general treatment, the treatment group received intravenous infusion of erythromycin at a dose of 3~5mg·kg·d mixed with 5% or 10% glucose solution 20ml per day for 7~10 days.
Efficacy determination criteria: markedly effective: vomiting ceased within 5 days, normal feeding resumed; effective: improvement within 7 days, vomiting ceased, normal feeding resumed; ineffective: after 7 days, children still vomited or gastric retention milk exceeded one-third of the previous feeding amount. In the treatment group of 36 cases, 23 cases were markedly effective, 11 cases were effective, and 2 cases were ineffective. The total effective rate was 94%. In the control group of 32 cases, 4 cases were markedly effective, 7 cases were effective, and 21 cases were ineffective. The total efficiency was 34%. The difference in total effective rate was significant (P<0.01).
Discussion: Erythromycin has a clear dose-effect relationship on gastrointestinal motility. Sub-therapeutic doses can induce gastrointestinal smooth muscle contraction and mobility movement complex waves; therapeutic doses disrupt normal mobility motor complexes, causing strong irregular contractions in the stomach and small intestine, often accompanied by vomiting. Intravenous administration of erythromycin at a dose of 5mg·kg·d accelerates gastric emptying time in children, reduces reflux index, significantly elevates plasma motilin levels, and obviously increases serum gastric secretion concentration. Application of low-dose erythromycin as a motilin agonist that combines with motilin receptors to produce prokinetic effects, such as increasing lower esophageal sphincter pressure and peristalsis 5~10cm proximal to the lower esophageal sphincter, stimulating antral contraction, promoting gastric emptying, and reducing reflux. Low-dose erythromycin treatment for neonatal vomiting can promote gastrointestinal motility, reduce reflux, with a total effective rate of 94%, showing statistically significant difference compared to the control group, and its effect is certainly worthy of promotion.