Azithromycin and Other Macrolides for Prevention of Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis

Nair, Vrinda; Loganathan, Prakash Kannan; Soraisham, Amuchou

doi:10.1159/000363493

Cited by 92 publications

(80 citation statements)

References 35 publications

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“…Ureaplasma spp. are the most common isolated organisms from chorioamniotic tissue after premature births 7) . Intra-uterine colonization and infections with Ureaplasma spp.…”

Section: Ureaplasma and Bpd -Epidemiologymentioning

confidence: 99%

“…Intra-uterine colonization and infections with Ureaplasma spp. led to altered lung development, prolonged inflammatory response and increased fibrotic reac tion in animal models [7][8][9][10] . In a previous meta-analysis, Wang and Schelonka, suggested that there is an association between postnatal Ureaplasma infection and BPD development 9,11) .…”

Section: Ureaplasma and Bpd -Epidemiologymentioning

confidence: 99%

“…Its clinical influence and relevance on the development of BPD and respiratory tract colonization has been demonstrated in four meta analyses in the past 20 years 7,9,11,13) . Further studies reported that the incidence of colonization ranged from rates 20…”

Section: Ureaplasma and Bpd -Epidemiologymentioning

confidence: 99%

“…Gastric fluid analysis shows 100% specificity in the identification, but if am niotic fluid tested positive for Ureaplasma and gastric fluid was negative, there was still a higher rate of neonatal mortality. azithromycin therapy 7) . Pharmacokinetic studies by Hassan et al 27,28) showed that azithromycin at a dose of 20 mg/kg/day for 3 days was safe and resulted in better clearance of Ureaplasma spp.…”

Section: Ureaplasma and Diagnosismentioning

confidence: 99%

“…In summary, there is limited evidence regarding the use of macrolides for the therapeutic treatment of Ureaplasma colonization or the prophylactic use for preventing BPD in preterm infants 7) . The time point, drug, and dose of antibiotic treatment needs to be studied in future clinical trials to optimize the outcome.…”

Section: Ureaplasma and Diagnosismentioning

confidence: 99%

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Bronchopulmonary Dysplasia andUreaplasma: What Do We Know So Far?

Haye

Hütten²,

Kunzmann

et al. 2017

Neonatal Med

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Bronchopulmonary dysplasia (BPD) is the most common morbidity of prematurity. BPD is a chronic respiratory disease related to lung-injury during the primary course of critical lung disease such as respiratory distress syndrome or when abnormal development of the preterm lung occurs. Abnormal lung development not only results from primary lung injury in the first days after birth, but also secondary injury through abnormal repair resulting in arrested and abnormal alveolarization, fibrosis and pulmonary vascular dysgenesis. Chorioamnionitis is a risk factor that plays an important role in the development of BPD. Ureaplasma subspecies (spp.) are the most common isolated organisms from chorioamniotic tissue after premature births. Therefore Ureaplasma spp. appear to play an important role in the development of BPD, and treatment or prophylactic treatment of these infections or coloni zation may reduce the incidence, morbidity and mortality of BPD. Ureaplasma spp. infections are challenging not only to treat, but also to diagnosis in a timely manner. This review summarizes the current state of treatment and new developments in the treatment of Ureaplasma exposure in premature infants.

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“…Ureaplasma spp. are the most common isolated organisms from chorioamniotic tissue after premature births 7) . Intra-uterine colonization and infections with Ureaplasma spp.…”

Section: Ureaplasma and Bpd -Epidemiologymentioning

confidence: 99%

Section: Ureaplasma and Bpd -Epidemiologymentioning

confidence: 99%

Section: Ureaplasma and Bpd -Epidemiologymentioning

confidence: 99%

Section: Ureaplasma and Diagnosismentioning

confidence: 99%

Section: Ureaplasma and Diagnosismentioning

confidence: 99%

See 3 more Smart Citations

Bronchopulmonary Dysplasia andUreaplasma: What Do We Know So Far?

Haye

Hütten²,

Kunzmann

et al. 2017

Neonatal Med

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Rates of Bronchopulmonary Dysplasia Following Implementation of a Novel Prevention Bundle

et al. 2021

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IMPORTANCE Bronchopulmonary dysplasia (BPD) rates in the United States remain high and have changed little in the last decade. OBJECTIVE To develop a consistent BPD prevention bundle in a systematic approach to decrease BPD. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study included 484 infants with birth weights from 501 to 1500 g admitted to a level 3 neonatal intensive care unit in the Kaiser Permanente Southern California system from 2009 through 2019. The study period was divided into 3 periods: 1, baseline (2009); 2, initial changes based on ongoing cycles of Plan-Do-Study-Act (2010-2014); and 3, full implementation of successive Plan-Do-Study-Act results (2015-2019).INTERVENTIONS A BPD prevention system of care bundle evolved with a shared mental model that BPD is avoidable. MAIN OUTCOMES AND MEASURESThe primary outcome was BPD in infants with less than 33 weeks' gestational age (hereafter referred to as BPD <33). Other measures included adjusted BPD <33, BPD severity grade, and adjusted median postmenstrual age (PMA) at hospital discharge.Balancing measures were adjusted mortality and adjusted mortality or specified morbidities. RESULTSThe study population included 484 infants with a mean (SD) birth weight of 1070 (277) g; a mean (SD) gestational age of 28.6 (2.9) weeks; 252 female infants (52.1%); and 61 Black infants (12.6%). During the 3 study periods, BPD <33 decreased from 9 of 29 patients (31.0%) to 3 of 184 patients (1.6%) (P < .001 for trend); special cause variation was observed. The standardized morbidity ratio for the adjusted BPD <33 decreased from 1.2 (95% CI, 0.7-1.9) in 2009 to 0.4 (95% CI, 0.2-0.8) in 2019. The rates of combined grades 1, 2, and 3 BPD decreased from 7 of 29 patients (24.1%) to 17 of 183 patients (9.3%) (P < .008 for trend). Grade 2 BPD rates decreased from 3 of 29 patients (10.3%) to 5 of 183 patients (2.7%) (P = .02 for trend). Adjusted median PMA at home discharge decreased by 2 weeks, from 38.2 (95% CI, 37.3-39.1) weeks in 2009 to 36.8 (95% CI, 36.6-37.1) weeks during the last 3 years (2017-2019) of the full implementation period. Adjusted mortality was unchanged, whereas adjusted mortality or specified morbidities decreased significantly. CONCLUSIONS AND RELEVANCEA sustained low rate of BPD was observed in infants after the implementation of a detailed BPD system of care.

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Interventions to Prevent Bronchopulmonary Dysplasia in Preterm Neonates

et al. 2022

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IMPORTANCE Bronchopulmonary dysplasia (BPD) has multifactorial etiology and long-term adverse consequences. An umbrella review enables the evaluation of multiple proposed interventions for the prevention of BPD. OBJECTIVE To summarize and assess the certainty of evidence of interventions proposed to decrease the risk of BPD from published systematic reviews. DATA SOURCES MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and Web of Science were searched from inception until November 9, 2020. STUDY SELECTION Meta-analyses of randomized clinical trials comparing interventions in preterm neonates that included BPD as an outcome. DATA EXTRACTION AND SYNTHESIS Data extraction was performed in duplicate. Quality of systematic reviews was evaluated using Assessment of Multiple Systematic Reviews version 2, and certainty of evidence was assessed using Grading of Recommendation, Assessment, Development, and Evaluation. MAIN OUTCOMES AND MEASURES (1) BPD or mortality at 36 weeks' postmenstrual age (PMA) and (2) BPD at 36 weeks' PMA.RESULTS A total of 154 systematic reviews evaluating 251 comparisons were included, of which 110 (71.4%) were high-quality systematic reviews. High certainty of evidence from high-quality systematic reviews indicated that delivery room continuous positive airway pressure compared with intubation with or without routine surfactant (relative risk [RR], 0.80 [95% CI, 0.68-0.94]), early selective surfactant compared with delayed selective surfactant (RR, 0.83 [95% CI, 0.75-0.91]), early inhaled corticosteroids (RR, 0.86 [95% CI, 0.75-0.99]), early systemic hydrocortisone (RR, 0.90 [95% CI, 0.82-0.99]), avoiding endotracheal tube placement with delivery room continuous positive airway pressure and use of less invasive surfactant administration (RR, 0.90 [95% CI, 0.82-0.99]), and volume-targeted compared with pressure-limited ventilation (RR, 0.73 [95% CI, 0.59-0.89]) were associated with decreased risk of BPD or mortality at 36 weeks' PMA. Moderate to high certainty of evidence showed that inhaled nitric oxide, lower saturation targets (85%-89%), and vitamin A supplementation are associated with decreased risk of BPD at 36 weeks' PMA but not the competing outcome of BPD or mortality, indicating they may be associated with increased mortality. CONCLUSIONS AND RELEVANCEA multipronged approach of delivery room continuous positive airway pressure, early selective surfactant administration with less invasive surfactant administration, early hydrocortisone prophylaxis in high-risk neonates, inhaled corticosteroids, and volume-targeted ventilation for preterm neonates requiring invasive ventilation may decrease the combined risk of BPD or mortality at 36 weeks' PMA.

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Azithromycin and Other Macrolides for Prevention of Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis

Cited by 92 publications

References 35 publications

Bronchopulmonary Dysplasia andUreaplasma: What Do We Know So Far?

Bronchopulmonary Dysplasia andUreaplasma: What Do We Know So Far?

Rates of Bronchopulmonary Dysplasia Following Implementation of a Novel Prevention Bundle

Interventions to Prevent Bronchopulmonary Dysplasia in Preterm Neonates

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