Supplementary Material for: Azithromycin for Prevention of Bronchopulmonary Dysplasia and Other Neonatal Adverse Outcomes in Preterm Infants: An Updated Systematic Review and Meta-Analysis

Introduction:
Azithromycin with its antimicrobial and anti-inflammatory properties has been explored as a potential option for preventing bronchopulmonary dysplasia (BPD) in preterm infants.
Objective:
We performed a meta-analysis of randomized controlled trials (RCTs) comparing azithromycin with placebo for the prevention of BPD in preterm infants.
Methods:
PubMed, Scopus, ClinicalTrials.gov, and Cochrane Central databases were searched for studies comparing azithromycin versus placebo in preterm infants. Outcomes of interest included the composite of bronchopulmonary dysplasia (BPD) and death, BPD, death, Grade 2 or higher necrotizing enterocolitis (NEC), Grade 3 or 4 intraventricular hemorrhage (IVH), retinopathy of prematurity (RoP), duration of mechanical ventilation, and postnatal corticosteroid requirement. Random effects model was used to generate risk ratio (RR), mean difference (MD), and 95% confidence interval (CI). (CRD42024558752).
Results:
The meta-analysis included 6 RCTs including 1,360 infants (azithromycin n=680, 50%). The composite of BPD or death (RR 0.95; 95%CI 0.83-1.10; p=0.53; I2=50.2%), BPD (RR 0.98; 95%CI 0.83-1.15; p=0.77; I2=38.1%), death (RR 0.88; 95%CI 0.66-1.19; p=0.41; I2=0%), NEC (RR 0.94; 95%CI 0.69-1.26; p=0.67; I2=0%), IVH (RR 1.22; 95%CI 0.89-1.68; p=0.22; I2=3.5%), RoP (RR 1.35; 95%CI 0.43-4.28; p=0.61; I2=76.3%), duration of mechanical ventilation (MD 0.13; 95%CI -1.35 to 1.60; p=0.87; I2=0%), and postnatal corticosteroid requirement (RR 0.84; 95%CI 0.64-1.08; p=0.18; I2=34.5%) were similar between the groups.
Conclusion:
In preterm infants, azithromycin did not significantly change the risk of adverse clinical outcomes compared with placebo.