Is metoclopramide safe for the premature infant?

BACKGROUND: Gastroesophageal reflux disease (GERD) may occur with poor weight gain, esophagitis, hematemesis and respiratory problems in an infant. Common treatment strategies include positioning, feeding thickeness, histamine2 receptor antagonists, antiacids, and prokinetics. Metoclopramide is a prokinetic drug used to treat GERD and it has been reported to be a most commonly prescribed medication in neonatal intensive care unit (NICU). This research involves a patient that was born at 30 weeks' gestation age and on the twentieth day of his admission, vomiting and gastric residuals were observed. All diseases which are related these symptoms were excluded. With no improvement observed following non-pharmacological interventions and metoclopramide was started with a dosage of 0.1 mg/kg, per dose 12 hours. After the second dose of metoclopramide, dystonic reactions occured. The premature infant was evaluated for differential diagnosis of the abnormal movements. No abnormal findings were reported. The dystonic reactions didn't recur after metoclopramide was stopped.
CONCLUSIONS: The observed adverse effects of metoclopramide in the preterm infant might be due to an excessive serum concentration of the drug as a result of its prolonged plasma clearance in this age group. Attention is drawn to the serious adverse effects of metoclopramide in the neonate, particularly premature infant.