Necrotizing Enterocolitis Is Associated With Ureaplasma Colonization in Preterm Infants

Abstract

The study objective was to determine whether Ureaplasma respiratory tract colonization of preterm infants <33 weeks gestation is associated with an increased risk for necrotizing enterocolitis (NEC). One or more tracheal or nasopharyngeal aspirates for Ureaplasma culture and PCR were obtained during the first week of life from 368 infants <33 weeks gestation enrolled from 1999-2003 or from 2007-2009. NEC Bell stage ≥2 was confirmed by radiological criteria, and pathology, if available. Cord serum samples were analyzed for IL-6 and IL-1β concentrations and placentas were reviewed for histological chorioamnionitis in the first cohort. NEC was confirmed in 29/368 (7.9%) of the combined cohorts. The incidence of NEC was 2.2-fold higher in Ureaplasma-positive (12.3%) than Ureaplasma-negative infants (5.5%) <33 wk (OR 2.43, 95%CI 1.13-5.22, P=0.023) and 3.3-fold higher in Ureaplasma-positive (14.6%) than Ureaplasma-negative (4.4%) infants ≤28 wks (OR 3.67, 95%CI 1.36-9.93, P=0.01). Age of onset, hematologic parameters at onset, and NEC severity were similar between Ureaplasma-positive and negative infants. Cord serum IL-6 and IL-1β concentrations were significantly higher in Ureaplasma-positive than in Ureaplasma-negative NEC-affected infants. Ureaplasma may be a factor in NEC pathogenesis in preterm infants by contributing to intestinal mucosal injury and/or altering systemic or local immune responses.

Gut microbiota, the immune system, and diet influence the neonatal gut–brain axis

“…This notion is conceptually correct because Ureaplasma parvum and Ureaplasma urealyticum are the most common organisms isolated from infected amniotic fluid, and are associated with preterm labor (59). Respiratory colonization with Ureaplasma doubles the risk of developing NEC in very preterm infants (60). The association of Ureaplasma with NEC still requires the molecular presence Review of this microbe in either surgical specimens or feces of infants who develop NEC.…”

Azithromycin and Other Macrolides for Prevention of Bronchopulmonary Dysplasia: A Systematic Review and Meta-Analysis

“…Ureaplasma infection induces production of tumor necrosis factor-α and interleukin-6 [11] and also causes apoptosis of human type 2 lung epithelial cells and lung macrophages [12]. Apart from BPD, Ureaplasma has also been associated with retinopathy of prematurity [13], intraventricular hemorrhage [14,15], necrotizing enterocolitis (NEC) [16] and adverse neurodevelopmental outcome [17]; all these associations could be attributed to the ability of Ureaplasma to elicit an inflammatory reaction.…”

Isolation of Separate Ureaplasma Species From Endotracheal Secretions of Twin Patients

“…Ureaplasma has been detected in gastric aspirate samples from preterm human neonates, and experimental intrauterine Ureaplasma infection in pregnant sheep was found to impair development of the fetal ovine gut in an IL-1-dependent manner. 12,13 In addition, Okogbule-Wonodi et al, 14 have reported a 2-fold increased NEC prevalence in Ureaplasma-infected neonates born <33 weeks and a 3.3-fold increase in those born <28 weeks with Ureaplasma infection.…”