Randomised trial of erythromycin on the development of chronic lung disease in preterm infants
a Neonatal Unit, Simpson Memorial Maternity
Pavilion, Lauriston Place, Edinburgh EH3 9YW, b Department Child Life and Health, University of Edinburgh, c Department Medical Microbiology, University of Edinburgh
Correspondence to: Dr A J Lyon.
Accepted 2 July 1997
AIMS
To determine if erythromycin given from birth
reduces the inflammatory response and the incidence and severity of
chronic lung disease.
METHODSSeventy 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 interluekins IL-1
and
IL-8, and tumour necrosis factor 
(TNF-) were measured. Chronic
lung disease (CLD) was defined as oxygen dependency at 36 weeks of gestation.
RESULTSNine 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 and IL-8 on admission: these babies had less
severe acute lung disease and developed significantly less CLD.
CONCLUSIONSU 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.
© 1998 by Archives of Disease in Childhood
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