Azithromycin for preventing bronchopulmonary dysplasia in preterm infants: A systematic review and meta-analysis
1Division of Neonatology, Department of Pediatrics, Princess Nourah Bint Abdulrahman University, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi Arabia.
Insights
Azithromycin may reduce bronchopulmonary dysplasia or death in preterm infants with Ureaplasma. However, overall evidence for azithromycin
Area of Science:
- Neonatal medicine
- Pediatric pulmonology
- Infectious diseases
Background:
- Bronchopulmonary dysplasia (BPD) is a significant complication in preterm infants.
- Ureaplasma is a potential contributor to lung injury and BPD.
- Azithromycin possesses anti-Ureaplasma and anti-inflammatory properties.
Purpose of the Study:
- To evaluate the efficacy and safety of azithromycin for preventing BPD in preterm infants.
- To assess the impact of azithromycin based on Ureaplasma status (unknown or proven).
Main Methods:
- A systematic review and meta-analysis of randomized clinical trials.
- Searched major databases (PubMed, Web of Science, Cochrane Library) up to September 2020.
- Assessed eligibility, risk of bias, and extracted data; used random-effects model and GRADE methodology.
Main Results:
- Meta-analysis of five trials showed no significant difference in BPD, death, or BPD/death for all infants (low-quality evidence).
- Azithromycin therapy significantly reduced BPD or death (RR, 0.83; 95% CI, 0.70-0.99) and trended towards lower BPD in Ureaplasma-positive neonates.
- A significant reduction in supplemental oxygen days (MD, -6.06 days) was observed with azithromycin.
Conclusions:
- Azithromycin therapy shows promise in reducing BPD or death in Ureaplasma-positive preterm infants.
- Current low-quality evidence does not support routine azithromycin use for all preterm infants to prevent BPD.
- Further research may clarify the role of azithromycin in specific neonatal populations.
Context:
Azithromycin has anti-Ureaplasma and anti-inflammatory properties that might help reduce lung injury in preterm infants.
Objective:
To test the efficacy and safety of prophylactic or therapeutic azithromycin in preventing bronchopulmonary dysplasia (BPD) in preterm infants with unknown or proven Ureaplasma status.
Methods:
We searched PubMed, Web of Science, and Cochrane Library until 13 September 2020. Two authors independently assessed the eligibility, risk of bias, and extracted the data. We performed a random-effects model meta-analysis to yield pooled relative risk (RR) or mean difference (MD) with 95% confidence interval (CI). We used the Cochrane GRADE methodology for summarizing the results.
Results:
We included five randomized clinical trials. The meta-analysis revealed no significant differences in BPD (RR, 0.92; 95% CI, 0.71, 1.19; low-quality evidence), death (RR, 0.75; 95% CI, 0.52, 1.10; low-quality evidence), and BPD or death (RR, 0.90; 95% CI, 0.74, 1.10; low-quality evidence). However, a significantly lower BPD or death (RR, 0.83; 95% CI, 0.70, 0.99) and a trend toward lower BPD (RR, 0.83; 95% CI, 0.66, 1.03) with azithromycin therapy was noted in Ureoplasma positive neonates. No differences in secondary outcomes were noted, except for significantly lower supplemental oxygen days with azithromycin (MD, -6.06; 95% CI, -7.40, -4.72; moderate-quality evidence). The test for subgroup differences between short (<7 days) and long (>7 days) course of azithromycin were nonsignificant for all the outcomes.
Conclusion:
Low-quality evidence suggests azithromycin therapy reduces BPD or death in preterm infants with positive Ureoplasma, but not in all preterm infants.
