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Randomised trial of erythromycin on the development of chronic lung disease in preterm infants
A J Lyon1, J McColm, L Middlemist
1Neonatal Unit, Simpson Memorial, Maternity Pavilion, Edinburgh.
Insights
Erythromycin treatment did not reduce chronic lung disease (CLD) in preterm infants. Ureaplasma urealyticum infection was not linked to increased inflammation or CLD severity.
Area of Science:
- Neonatal Medicine
- Pediatric Pulmonology
- Infectious Diseases
Background:
- Preterm infants are susceptible to chronic lung disease (CLD).
- Ureaplasma urealyticum (U urealyticum) is a common pathogen in neonatal intensive care units.
- The role of U urealyticum in neonatal inflammation and CLD requires further investigation.
Purpose of the Study:
- To evaluate the efficacy of erythromycin in mitigating the inflammatory response.
- To determine if erythromycin reduces the incidence and severity of CLD in very preterm infants.
- To assess the association between U urealyticum and neonatal inflammatory markers.
Main Methods:
- A randomized controlled trial involving 75 infants (<30 weeks gestation) requiring ventilation.
- Infants received either intravenous erythromycin for 7 days or no treatment.
- Tracheal U urealyticum detection, bronchoalveolar lavage differential cell counts, and cytokine (IL-1 beta, IL-8, TNF-alpha) measurements were performed.
Main Results:
- U urealyticum was detected in 13% of infants; no association with increased cytokine levels or CLD was found.
- Erythromycin treatment did not significantly alter inflammatory cell counts or cytokine concentrations compared to the control group.
- The incidence of CLD was similar between erythromycin-treated and non-treated infants.
Conclusions:
- Erythromycin administration did not reduce the incidence or severity of CLD in preterm infants.
- Tracheal U urealyticum colonization was not associated with an enhanced inflammatory response in this cohort.
- Chorioamnionitis was linked to higher initial inflammatory cytokine levels but lower CLD development.
Aims:
To determine if erythromycin given from birth reduces the inflammatory response and the incidence and severity of chronic lung disease.
Methods:
Seventy five infants less than 30 weeks of gestation and ventilated from birth for lung disease were randomly assigned to receive erythromycin intravenously for 7 days or to no treatment. Ureaplasma urealyticum was detected in tracheal secretions by culture and polymerase chain reaction. Differential cell counts were obtained from bronchoalveolar lavage fluid collected daily for 5 days and concentrations of the cytokines interleukins IL-1 beta and IL-8, and tumour necrosis factor alpha (TNF-alpha) were measured. Chronic lung disease (CLD) was defined as oxygen dependency at 36 weeks of gestation.
Results:
Nine infants (13%) were positive for U urealyticum. The inflammatory cytokines in the lungs increased over the first 5 days of life in all babies, but no association was found between their concentrations and the development of CLD. Those treated with erythromycin showed no significant differences from the non-treated group in the differential cell counts or concentrations of the cytokines. The two groups had a similar incidence of CLD. Babies infected with U urealyticum did not have a more pronounced cytokine response than those without infection. Chorioamnionitis was associated with significantly higher concentrations of IL-1 beta and IL-8 on admission: these babies had less severe acute lung disease and developed significantly less CLD.
Conclusions:
U urealyticum in the trachea was not associated with an increased inflammatory response in preterm infants. Erythromycin did not reduce the incidence or severity of CLD.