The use of cisapride in neonates
Editor—In response to the annotation of Markiewicz and Vandenplas,1 in which they give the indications for the use of cisapride in neonates, I performed a Medline search using the search terms “cisapride” and “infant, newborn”. This disclosed only three randomised controlled trials of cisapride versus placebo in neonates.2-4 One other study compared cisapride with placebo in infants, but only a subgroup of this study population were neonates (number not stated).5 None of these studies were referenced in their annotation.1Surely in these days of evidenced based medicine, direct examination of the evidence available is mandatory.
The results of the trials found in my search show that cisapride is only effective in: treating ileus after abdominal surgery4; reducing the number of gastric residuals in nasogastrically fed preterm infants3; and decreasing the incidence of regurgitation in preterm infants.3Specifically cisapride was not effective in reducing the time taken to achieve full enteral feeds in preterm infants,3 and may delay gastric emptying in preterm infants.2
Furthermore it could be argued that gastro-oesophageal reflux is a non-pathological state in neonates, and only if it leads to complications (secondary respiratory disease, oesophagitis) does it require treatment. No randomised controlled trial of cisapride versus placebo in neonates has been published that looks at these clinically relevant outcomes.
I would therefore argue that, given the side effect profile, the only indications for cisapride in neonates are treatment of postoperative ileus and, possibly, treatment of regurgitation leading to complications. At present there is no evidence that it is effective for use in neonates in any other circumstance.
