The document presents results from a study that evaluated the role of clarithromycin in preventing bronchopulmonary dysplasia (BPD) in preterm newborns who tested positive for Ureaplasma urealyticum. 224 preterm infants were randomly assigned to either receive clarithromycin treatment (n=37) or no treatment (n=37) if they tested positive for Ureaplasma. Infants who received clarithromycin saw a 68.5% eradication rate of the bacteria compared to those who did not receive treatment. The study suggests clarithromycin may help prevent BPD in preterm infants with Ureaplasma infections.

1. Presented By:
Dr. Shergul Solangi
DCH Trainee
LGH/PGMI 1

2.  BPD
 Ureaplasma Urealyticum
 Clarithromycin
 Research Paper introduction
 Survey
 Results
 Conclusion
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3.  BPD stands for Broncho Pulmonary Dysplasia
 Definition
 Serious and chronic lung disease of newborn marked
by chronic inflammation of airways
 Causes
 Preterm
 RDS (Respiratory distress Syndrome)
 Oxygen Toxicity
 Mechanical Lung Trauma
 Infection
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4.  Mechanism
 Lungs of babies with BPD are immature or have not
developed normally, therefore, lungs are unable to
perform the exchange or incomplete exchange of
gases occur.
 Occurrence
 BPD developed mostly during first 4 weeks of life.
 90% of infants who developed BPD are premature
and having weight less than 1500gm
 Male>Female
 Non African increased ratio
 Genetic factor plays role
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5.  Signs /Symptoms
 Tachypenia
 Subcostal recession
 Wheezing
 Diagnosis
 History
 Need of oxygen after 28 days
 Persistence of sign and symptoms
 X-Ray chest
Note: Most important criteria for diagnosis is need of oxygen even
after 28 days
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6.  Treatment
 Note: no specific treatment of BPD
 Oxygen supplementation
 Surfactant administration
 Mechanical ventilation
 I/V fluids
 Bronchodilator
 Corticosteroids
 I/V antibiotics
 Physical therapy
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7. 7

8.  Introduction
 It is a gram negative Ds DNA bacteria
 Found in urogenital tract
 It is normal commensally flora in reproductive
tract especially in women
 Transmission is mostly vertical
 vertical transmissin in full term is 18 to 55%
 vertical transmission in preterm is 29to 60%
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9.  Macrolides
 It prevents protein synthesis of bacteria
 It is more effective than erythromycin
 Note: it’s concentration is 10 times more in tissues than plasma especially
in liver and lungs
 Uses
 Pharygitis
 Tonsilitisitis
 Sinusitis
 chronic bronchitis
 Pneumonia
 Side effects
 Jaundice
 Renal failure
 Ototoxity
 Risk of oral candidiasis
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10.  Brief introduction
 Published on: November 28,2011(Online this December)
 Researchers : Ramazan Ozdemir et all.
 Research place: Zekai Tahir Burak Meternity Teaching Hospital
Ankara, Turkey
 Total neonate studied 272 (48 excluded due to major congenital
problems, so net total newborn studied were 224)
 Gestational age 27 to 28 weeks
 Weight 750 to 1250 gms
 Method: Nasopharyngeal swabs for 1st 3 post natal days
 Result of culture obtained in max. 48 hours
 All culture +ve patients followed up to 36 weeks of post
menstrual age .
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11. Role of clathromycin in
preventing bronchopulmonary
dysplasia in ureaplasma
urelyticum Culture positive
preterm newborns
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12.  Nasopharyngeal swabs for ureaplasma
urelyticum culture obtained in the first 3 post
natal days having birth weight 750 – 1250 gms
and having gestational age 27-28 weeks
 Infants with +ve culture assigned into two
groups . 1) Treated with clathromycin 2) not
treated with clathromycin

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13. Assessed for enrollment
(N=272)
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14. Excluded (n=48)
Assessed for enrollment -Major congenital abnormalties (n=7)-
(N=272) Refused to participate (n=21)
-Death (n=12)
-Intrauterine growth retardation (n=8)
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15. Excluded (n=48)
Assessed for enrollment -Major congenital abnormalties (n=7)-
(N=272) Refused to participate (n=21)
-Death (n=12)
-Intrauterine growth retardation (n=8)
Randomly assigned Culture-negative (n=150)
Culture –positive (n=74) -Death (n=12)
15

16. Excluded (n=48)
Assessed for enrollment -Major congenital abnormalties (n=7)-
(N=272) Refused to participate (n=21)
-Death (n=12)
-Intrauterine growth retardation (n=8)
Randomly assigned Culture-negative (n=150)
Culture –positive (n=74) -Death (n=12)
Clathromycin treatment given
(n= 37)
16

17. Excluded (n=48)
Assessed for enrollment -Major congenital abnormalties (n=7)-
(N=272) Refused to participate (n=21)
-Death (n=12)
-Intrauterine growth retardation (n=8)
Randomly assigned Culture-negative (n=150)
Culture –positive (n=74) -Death (n=12)
Clathromycin treatment given Clathromycin treatment not given
(n= 37) (n= 37)
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18. Excluded (n=48)
Assessed for enrollment -Major congenital abnormalties (n=7)-
(N=272) Refused to participate (n=21)
-Death (n=12)
-Intrauterine growth retardation (n=8)
Randomly assigned Culture-negative (n=150)
Culture –positive (n=74) -Death (n=12)
Clathromycin treatment given Clathromycin treatment not given
(n= 37) (n= 37)
Discontinued intervention
Death: spsis (1),
Necrotizig enterocolitis (1)
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19. Excluded (n=48)
Assessed for enrollment -Major congenital abnormalties (n=7)-
(N=272) Refused to participate (n=21)
-Death (n=12)
-Intrauterine growth retardation (n=8)
Randomly assigned Culture-negative (n=150)
Culture –positive (n=74) -Death (n=12)
Clathromycin treatment given Clathromycin treatment not given
(n= 37) (n= 37)
Discontinued intervention Discontinued intervention
Death: spsis (1), Death: spsis (3),
Necrotizig enterocolitis (1) Necrotizig enterocolitis (1)
19

20. Excluded (n=48)
Assessed for enrollment -Major congenital abnormalties (n=7)-
(N=272) Refused to participate (n=21)
-Death (n=12)
-Intrauterine growth retardation (n=8)
Randomly assigned Culture-negative (n=150)
Culture –positive (n=74) -Death (n=12)
Clathromycin treatment given Clathromycin treatment not given
(n= 37) (n= 37)
Discontinued intervention Discontinued intervention
Death: spsis (1), Death: spsis (3),
Necrotizig enterocolitis (1) Necrotizig enterocolitis (1)
Analyzed: 35
20

21. Excluded (n=48)
Assessed for enrollment -Major congenital abnormalties (n=7)-
(N=272) Refused to participate (n=21)
-Death (n=12)
-Intrauterine growth retardation (n=8)
Randomly assigned Culture-negative (n=150)
Culture –positive (n=74) -Death (n=12)
Clathromycin treatment given Clathromycin treatment not given
(n= 37) (n= 37)
Discontinued intervention Discontinued intervention
Death: spsis (1), Death: spsis (3),
Necrotizig enterocolitis (1) Necrotizig enterocolitis (1)
Analyzed: 35 Analyzed: 33
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22.  When positive culture obtained after 48 hrs
.Clathromycin treatment started for 10
days
 10 mg per kg IV BD for 10 days.
Clathromycin treatment results in
eradication of ureaplasma
urealticum in 68.5%.
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23. UREAPLASMA UREALYTICUM POSITIVE UREAPLASMA UREALYTICUM POSITIVE
TREATED WITH CLATHROMYCIN NOT TREATED WITH CLATHROMYCIN
Birth weight 988 gms Birth weight 978gms
Gestational 27 wks Gestational age 27 wks
Male 13(37) Male 17(33)
C-section 22(35) C-section 19(33)
Prenatal steriods 24(35) Prenational steriods 20(330
Prom p0sitive 7(35) Prom POSITIVE 3(33)
Chorioamniotis 1(35) Chorioamnotis 0(33)
Sepsis 16(35) Sepsis 14(33)
Pneumonia 3(35) Pneumonia 3(33)
PDA 10(35) PDA 15(33)
Rds 20(35) RDS 21(33)
Poractant RX 11(35) Poractant@ RX 13(33)
Caffeine RX 26(35) Caffeine rx 28(33)
Diuretic Rx 3(35) Diuretic rx 1(33)
Duration of M.VENT; 1.8 (4.7) Duration of M.vent 3.1(4.6)
Duration of CPAP 3.7 (3.6) Duration of CPAP 5.8(6.2)
BPD at 36 wks 01(35 ) BPD at 36 wks 12(33)
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24.  The rate of BPD development was
significantly higher in patients with
u.urealyticum culture positive patients that’s
36% as compared to those who are u
.urealyticum neg;culture that’s 15%
The incidence of BPD is significantly lower in
clathromycin treated patients that’s 2.9% as
compared to non treated that’s 36%.
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25.  Clathromycin treatment prevents
developments of BPD,in preterms who are
born at 750 to 1250 gms,colonized with
ureaplasma urealyticum and only 01 case of
BPD noted ( out of 35 culture positive cases)
who are treated with clathromycin,while 12
cases of BPD noted (out of 33 culture poitive
patient) who are not treaed with
clathromycin.
25

26.  Though this study markedly reduces the
occurrence of BPD who are ureaplasma urea
lyticum positive pts,treated with
claththromycin ,but not gives strong
association,of ureaplasma urealyticum to
develop BPD.
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27. T0tal studied
224
u.urelyticum positive (74) u.urealyticum negative( 138)
CLATHROMYCIN(35) NOT RX CLATHRO;(33)
BPD1 (35)-2.9% BPD 12(33) -36.4% 22(138) 15.9%
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