Treatment Could Help Save Preterm Infants

LEXINGTON, Ky. (May 2, 2011) — The following column appeared in the Lexington Herald-Leader on Sunday, May 1. 

Research shows potential for treating certain preterm infants
By Dr. Hubert Ballard

Premature birth, also called preterm birth, is a major problem in Kentucky. Preterm birth is defined as any baby born before it reaches full term — 37 weeks of gestation.

In Kentucky our preterm birth rate is 14 percent, compared to a national rate of 12.5 percent. Nearly one out of every seven babies born in this state is premature. Although every pregnancy comes with some chance of preterm birth, there are medical and lifestyle factors that can increase the risk in pregnant women.

Strategies that future moms can use to decrease the chance of delivering a baby early include getting good preconception and early prenatal care. Smokers are encouraged to quit. Women who have a history of delivering early can try progesterone therapy to avoid another preterm birth.

So why is being born early such a problem? Because these babies haven't had time to fully develop, especially if they are born extremely early. While not all preterm infants have health problems, many do, and at a much higher rate than babies born full term.

As a neonatologist at the University of Kentucky, I care for very premature infants. Because these babies have underdeveloped lungs, they're much more likely to have difficulty breathing or to develop lung infections. One of the major problems these babies face is a lung condition called bronchopulmonary dysplasia (BPD).

Lung immaturity is the leading cause of death among premature infants, which frequently progresses into BPD as they grow.  BPD is characterized by inflammation and scarring in the lungs. Even babies who survive BPD face a greater chance of developing recurrent respiratory infections, such as pneumonia or bronchiolitis; and almost 50 percent are readmitted to the hospital during the first year after discharge from the neonatal intensive care unit (NICU).

Treatment options for preventing BPD are currently few and far between. However, a study done here at UK showed results that may be promising for treating certain infants at risk for developing BPD.

The study was performed on 220 preterm infants admitted to the UK NICU from 2004 to 2008. All infants for the study weighed less than two pounds, 12 ounces; all were on mechanical ventilation to help with their lung immaturity.

For six weeks, the infants received either a weight-appropriate dose of azithromycin — the same antibiotic you take in a Z-Pak — or a placebo.

Upon completion of the study, we noticed a significant trend. Babies who received the antibiotic and who were already infected or colonized with Ureaplasma bacteria were 21 percent less likely to develop BPD.

Presence of the Ureaplasma bacterium is a big risk factor for developing BPD. An estimated 80 percent of women have this bacterium in their system, and it is easily passed on from mother to child. For preterm babies, who often have weaker immune systems than their full-term counterparts, the inflammation from this bacterial infection often leads to full-fledged BPD.

More research is needed to study azithromycin therapy for the routine treatment of premature infants who have Ureaplasma in their system. But we believe that with early identification and treatment of these babies, we can really lower their chance of developing bronchopulmonary dysplasia.

Dr. Hubert Ballard is a an assistant professor of pediatrics at the University of Kentucky.