Effectiveness Of Azithromycin For Preventing Bronchopulmonary Dysplasia In Preterm Infants:a Systematic Review

Objective: The aim of the study is to assess theeffectiveness and safety of azithromycin for preventingbronchopulmonary dysplasia（BPD）in preterm infants.The purpose is toprovide reference for clinical mediation of BPD. Methods: Firstly，thesearching strategy was established.Then the electronic searches wereconducted to retrieve Randomized Controlled trials （RCTs） from TheCochrane Library， Pubmed， Embase， China Biological MedicineDatabase（CBM），Chinese Journals full-text Database（CNKI），ChineseTechnological Journals Database（VIP）and Wan Fang Digital JournalFull-text Database by free texts and Medical subject headings tillDecember2012. Conference proceedings were searched， and allreferences in all included trials were searched，too. All published trialsutilizing random or quasi-random patient allocation in which treatmentwith azithromycin was compared with placebo or no treatment to preventBPD in preterm or low birth weight infants were included. The risk biasesof the RCTs were assessed. Two reviewers extracted and cross checkeddata independently. Statistical analysis was performed by fixed effectmodel or random effect model of Meta-analysis using Revman5.1which offered by Cochrane. Result: A total of2trials involving328preterminfants were included. One trial had two unclear risk bias.①Nosignificant difference was observed between the azithromycin group andthe control group in the incidence of BPD（RR0.81，95%CI0.55to1.19）.②The risk ratio of death in the azithromycin group was lower，but notsignificantly（RR0.82，95%CI0.48to1.39）.③Post-natal steroid use inthe azithromycin group was lower，but not significantly（RR0.79，95%CI0.46to1.33）.④The risk ratio of length of stay was not significantlydifferent，but there was a trend favoring the control group（MD3.12，95%CI-3.50to9.74）.⑤When analyzing the Ureaplasma subgroup，theincidence of BPD was significantly less in the azithromycin group.⑥Noadverse reactions were observed because of azithromycin. Conclusion:There is insufficient evidence from randomized trials to either support orrefute the use of prophylactic azithromycin in preterm infants to preventBPD. Further studies of azithromycin to prevent BPD in the Ureaplasmacolonized preterm infants are warranted. Comparing azithromycin tocontrol，azithromycin has no significant effect in reducing the use ofpost-natal steroid and the death or length of stay. No adverse reactionswere observed because of azithromycin. Existing data are insufficient tomake a recommendation regarding treatment with prophylacticazithromycin to prevent BPD in preterm infants. Considering themethodological and scale limitation and heterogeneity of included studies and the bias of meta-analysis， more RCTs with large-scale andhigh-quality are required to provide more reliable evidence.