Nurse Discusses Reglan Use in Infants

Lexington, GATerry P, a nurse in Georgia, worked with premature babies in a Neonatal Intensive Care Unit (NICU). She says she cannot remember a single premature baby in her care who was not given Reglan, despite the fact that there is still little information available about the long-term effects of Reglan on infants.

"Reglan is used to help with gut motility," Terry says. "It's used for premature babies because their bodies are not ready to work like yours and mine. When you try to feed them, their peristalsis [muscle contractions that move food through the digestive tract] is not as efficient. Doctors try to boot it up with Reglan."

However, Reglan is also used to enhance breast milk production, and Terry says infants could be exposed to even greater quantities of the drug that way.

"There was one doctor in particular who was a 'breastfeed your baby or you'll kill it' doctor," says Terry. "Some women can't do it. Breast milk is the best thing for babies—they can digest it best. But not all women can do it. This doctor was writing prescriptions for Reglan to increase breast milk production."

Premature babies have a premature neurological system, which means they react to noise, touch and other stimulus by becoming jittery and moving their arms and legs up and down. "Even sound will cause that jitteriness," Terry says. "But they shouldn't stay that way all the time."

Under normal circumstances, the infant can be calmed down. "But if the drug is increasing that jitteriness, they're messing the babies up by giving them Reglan," says Terry. "The thing is, they were all on Reglan. There was not one premature baby who was not given Reglan.

"They were given Reglan as soon as feeding was incorporated. Say there is a baby who is 24 weeks gestation—normal is approximately 40 weeks. Once the baby is stabilized and the blood oxygen is good, they start tube feeding the baby and start the Reglan with the feeding so that the gut will contract like a normal gut and the food will move through. That could be as soon as a week after birth.

"The thing is, you might be giving the infant only a small amount of Reglan, but when you weigh only 500 grams, that's a lot of medication to take in."

Reglan now carries a black box warning alerting patients to the risk of tardive dyskinesia, especially if the drug is used for longer than 12 weeks. However, some critics argue there is still insufficient evidence to show that Reglan is safe for infants. According to the labeling information, serious Reglan side effects "happen more often in children and adults under age 30," including uncontrolled spasms of the face and neck muscles, or muscles of the body, arms and legs.

If you have an infant who was treated with Reglan and are worried about potential side effects, contact a doctor to discuss your concerns.