Erythromycin
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Hypertrophic pyloric stenosis in neonates: 2 case reports Two 15-week-old monochorionic premature male neonates developed hypertrophic pyloric stenosis following treatment with erythromycin for gastrointestinal dysmotility and promotion of enteral feeding. The twins were born at 25 weeks of gestation weighing 764g (patient 1) and 720g (patient 2). They started receiving IV erythromycin 20 mg/kg/day from days 1–14 (patient 1) or days 1–10 (patient 2). Breast feeding was initiated within 48 hours after birth, and both neonates were receiving full feeds 34 days later. During the 15th week of life (40 weeks of corrected age), both twins developed feeding intolerance, loose stools, abdominal distension, postprandial non-bilious vomiting and low activity levels. No pathology was noted on plain abdominal x-rays. IV feeding was commenced. At the age of 16 weeks, findings from abdominal ultrasounds and upper intestinal x-rays were consistent with hypertrophic pyloric stenosis in both neonates. Both twins underwent Fredet-Ramstedt pyloromyotomy at the age of 116 days (41 weeks of corrected age) followed by an uneventful recovery. Author comment: "[W]e speculate that i.v. erythromycin administration soon after birth may promote earlier expression of motilin receptor in extremely premature infants, thereby resulting in [hypertrophic pyloric stenosis] in the present case." Shoji H, et al. Hypertrophic pyloric stenosis in mono-ovular extremely preterm twins after use of erythromycin. Pediatrics International 50: 701-702, No. 5, Oct 801124518 2008 - Japan
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Reactions 8 Nov 2008 No. 1227
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