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Lowe J, Gillespie D, Aboklaish A, Lau TMM, Consoli C, Babu M, Goddard M, Hood K, Klein N, Thomas-Jones E, Turner M, Hubbard M, Marchesi J, Berrington J, Kotecha S. Azithromycin therapy for prevention of chronic lung disease of prematurity (AZTEC): a multicentre, double-blind, randomised, placebo-controlled trial. THE LANCET. RESPIRATORY MEDICINE 2024; 12:608-618. [PMID: 38679042 DOI: 10.1016/s2213-2600(24)00079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/05/2024] [Accepted: 03/05/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Systematic reviews have reported conflicting evidence on whether macrolide antibiotics reduce rates of chronic lung disease of prematurity (CLD) in at-risk preterm infants born at less than 30 weeks' gestation, including in those colonised with pulmonary Ureaplasma spp. Since an adequately powered trial has been lacking, we aimed to assess if the macrolide azithromycin improved survival without the development of physiologically defined moderate or severe CLD in preterm infants. METHODS AZTEC was a multicentre, double-blind, randomised, placebo-controlled trial conducted in 28 tertiary neonatal intensive care units in the UK. Infants were eligible if they were born at less than 30 weeks' gestation and had received at least 2 h of either non-invasive (continuous positive airway pressure or humidified high flow nasal cannula therapy) or invasive respiratory support (via endotracheal tube) within 72 h of birth. Eligible infants were randomly allocated in a 1:1 ratio using random permuted blocks of four to receive either intravenous azithromycin at 20 mg/kg per day for 3 days followed by 10 mg/kg for 7 days, or to placebo. Allocation was stratified by centre and gestational age at birth (<28 weeks vs ≥28 weeks). Azithromycin and placebo vials were encased in tamper-evident custom cardboard cartons to ensure masking for clinicians, parents, and the research team. The primary outcome was survival without development of physiologically defined moderate or severe CLD at 36 weeks' postmenstrual age. Outcomes and safety were analysed on an intention-to-treat basis (all randomly allocated infants, regardless of any post-randomisation events). The study was registered with ISRCRN (11650227) and is closed. FINDINGS Infants were recruited between Oct 9, 2019, and March 22, 2022. 799 (53·1%) of 1505 eligible infants underwent random allocation; three infants were withdrawn, including consent to use their data, leaving 796 infants for analysis. Survival without moderate or severe CLD occurred in 166 (42%) of 394 infants in the intervention group and 179 (45%) of 402 in the placebo group (three-level adjusted OR [aOR] 0·84, 95% CI 0·55-1·29, p=0·43). Pulmonary Ureaplasma spp colonisation did not influence treatment effect. Overall, seven serious adverse events were reported for the azithromycin group (five graded as severe, two as moderate), and six serious adverse events were reported in the placebo group (two severe, two moderate, and two mild), as assessed by the local principal investigators. INTERPRETATION Since prophylactic use of azithromycin did not improve survival without development of physiologically-defined CLD, regardless of Ureaplasma spp colonisation, it cannot be recommended in clinical practice. FUNDING UK National Institute for Health and Care Research.
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Affiliation(s)
- John Lowe
- Centre For Trials Research, Cardiff University, Cardiff, UK
| | | | - Ali Aboklaish
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK
| | | | - Claudia Consoli
- Central Biotechnology Services, Cardiff University, Cardiff, UK
| | - Malavika Babu
- Centre For Trials Research, Cardiff University, Cardiff, UK
| | - Mark Goddard
- Centre For Trials Research, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Centre For Trials Research, Cardiff University, Cardiff, UK
| | - Nigel Klein
- Institute of Child Health, University College London, London, UK
| | | | - Mark Turner
- Women and Children's Health, University of Liverpool, Liverpool, UK
| | - Marie Hubbard
- Neonatal Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Julian Marchesi
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Janet Berrington
- Neonatal Medicine, Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne, UK; Translational and Clinical Research Institute, Newcastle University, Newcastle, UK
| | - Sailesh Kotecha
- Department of Child Health, Cardiff University School of Medicine, Cardiff, UK.
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Oliver BG, Foster PS. To burn or not to burn: similar effects of different types of prenatal tobacco exposure on infant lung function. ERJ Open Res 2024; 10:00294-2024. [PMID: 38978549 PMCID: PMC11228605 DOI: 10.1183/23120541.00294-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 04/03/2024] [Indexed: 07/10/2024] Open
Abstract
The first study to describe the harmful effects of snus on the unborn infant provides evidence to help clinicians and mothers collectively to make an informed choice about quitting the use of snus before planning pregnancies https://bit.ly/3vJnBxW.
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Affiliation(s)
- Brian G Oliver
- School of Life Sciences, University of Technology Sydney, Ultimo, NSW, Australia
- The Woolcock Institute of Medical Research and Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Paul S Foster
- The Woolcock Institute of Medical Research and Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
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Halvorsen T. Ambient Air Pollution and Morbidities in Bronchopulmonary Dysplasia; It's All about the Money. Ann Am Thorac Soc 2024; 21:34-36. [PMID: 38156899 PMCID: PMC10867906 DOI: 10.1513/annalsats.202310-893ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024] Open
Affiliation(s)
- Thomas Halvorsen
- Department of Pediatrics, Haukeland University Hospital, Bergen, Norway; and
- Department of Clinical Science, University of Bergen, Bergen, Norway
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