research paper presentation

1

Clarithromycin in preventing Bronchopulmonary

Dysplasia(BPD) in Ureaplasma Urealyticum(Culture positive)

preterm infants

Presented By:Dr. Shergul Solangi

DCH TraineeLGH/PGMI

2

Contents

BPD Ureaplasma Urealyticum Clarithromycin Research Paper introduction

SurveyResults

Conclusion

3

BPD

BPD stands for Broncho Pulmonary Dysplasia

DefinitionSerious and chronic lung disease of newborn

marked by chronic inflammation of airways Causes

PretermRDS (Respiratory distress Syndrome)Oxygen ToxicityMechanical Lung Trauma Infection

4

Continued…

MechanismLungs 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.

OccurrenceBPD developed mostly during first 4 weeks of life.90% of infants who developed BPD are premature

and having weight less than 1500gmMale>FemaleNon African increased ratioGenetic factor plays role

5

Continued…

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

6

Continued…

TreatmentNote: no specific treatment of BPDOxygen supplementationSurfactant administrationMechanical ventilation I/V fluidsBronchodilatorCorticosteroids I/V antibioticsPhysical therapy

7

BPD X-RAY

8

Ureaplasma Urealyticum

IntroductionIt is a gram negative Ds DNA bacteriaFound in urogenital tractIt is normal commensally flora in

reproductive tract especially in womenTransmission is mostly verticalvertical transmissin in full term is 18 to

55% vertical transmission in preterm is 29to

60%

9

Clarithromycin

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

10

Research Paper (AAP)

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 .

11

Role of clathromycin in preventing

bronchopulmonary dysplasia in ureaplasma

urelyticum Culture positive preterm

newborns

12

Patients and methods

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

13

Assessed for enrollment(N=272)

14


Excluded (n=48)-Major congenital abnormalties (n=7)-Refused to participate (n=21)-Death (n=12)-Intrauterine growth retardation (n=8)

15



Randomly assignedCulture –positive (n=74)

Culture-negative (n=150)-Death (n=12)

16





Clathromycin treatment given

(n= 37)

17






(n= 37)

Clathromycin treatment not given (n= 37)

18






(n= 37)


Discontinued interventionDeath: spsis (1),

Necrotizig enterocolitis (1)

19






(n= 37)






20






(n= 37)






Analyzed: 35

21






(n= 37)






Analyzed: 35 Analyzed: 33

22

Treatment given

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%.

23

Characteristics and out comes of ureaplasma

urealyticum positive patients treted with clathromycin or NOT.

UREAPLASMA UREALYTICUM POSITIVE TREATED WITH CLATHROMYCIN

Birth weight 988 gmsGestational 27 wksMale

13(37)C-section 22(35)Prenatal steriods 24(35)Prom p0sitive 7(35)Chorioamniotis 1(35)

Sepsis

16(35)Pneumonia 3(35)PDA 10(35)Rds 20(35)Poractant RX 11(35)Caffeine RX 26(35)Diuretic Rx 3(35)Duration of M.VENT; 1.8 (4.7)Duration of CPAP 3.7 (3.6)BPD at 36 wks 01(35 )

UREAPLASMA UREALYTICUM POSITIVE NOT TREATED WITH CLATHROMYCIN

Birth weight 978gmsGestational age 27 wksMale 17(33) C-section 19(33)Prenational steriods 20(330Prom POSITIVE 3(33)Chorioamnotis 0(33)Sepsis 14(33)Pneumonia 3(33)PDA 15(33)RDS 21(33)Poractant@ RX 13(33)Caffeine rx 28(33)Diuretic rx 1(33)Duration of M.vent 3.1(4.6)Duration of CPAP 5.8(6.2)BPD at 36 wks 12(33)

24

RESULTS

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%.

25

conclusion

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.

26

Continued;

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.

27

SUMMARY

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%

28

MESSAGE

29

QUESTIONS 16 -12 -2011

research paper presentation

Health & Medicine