938 ALTERATIONS IN STOOL FLORA DURING ORAL KANAMYCIN PROPHYLAXIS OF NECROTIZING ENTEROCOLITIS (NEC)

Abstract

Oral Kanamycin prophylaxis may protect premature infants from NEC presumably by suppressing enteric colonization. In a randomized double-blind study, 49 infants received 5 mg/kg t.i.d. of Kanamycin orally 24 hrs. prior to the first feed and continued for 24 days and 50 were given placebo. The gestational ages (31.9 ± 2.1 wk M ± SEM) and birth weights (1.6 ± 0.4 kg) were comparable between the 2 groups. Treated infants had significant reduction (p <0.05) in the rate of coliform colonization on day 3-5 (12 vs. 42%), 10 (32 vs. 60%), 17 (50 vs. 82%) and 24 (57 vs. 87%). Three of 49 treated infants with negative flora developed NEC, compared to 9 of 50 controls, 7 of whom had significant enteric colonization. The prophylaxis did not significantly alter the incidence of NEC but suggests a partial protection. Prophylaxis also produced a significant increase in the prevalence of Kanamycin resistant coliforms in treated infants by day 17 and 24 (48 vs. 24%, (p <0.05). Because of proportionately small number of treated infants relative to nursery population (no more than 5 of 35 were being treated) nursery epidemiologic surveillance revealed no increase in Kanamycin resistant organisms during the study period. Thus, Kanamycin prophylaxis may be recommended for partial protection from NEC, but due to the emergence of potentially pathogenic Kanamycin resistant coliforms, should be used only in a limited group of high risk infants to maintain a low proportion of treated infants within the nursery population.

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