Role of Ureaplasma urealyticum in lung disease of prematurity

Abstract

Aim-To examine the role of Ureaplasma urealyticum colonisation or infection in neonatal lung disease. Methods-Endotracheal aspirates from ventilated infants less than 28 weeks of gestation were cultured for U urealyticum and outcomes compared in infants with positive and negative cultures. Results-U urealyticum was isolated from aspirates of 39 of 143 (27%) infants. Respiratory distress syndrome (RDS) occurred significantly less often in colonised, than in non-colonised infants (p=0.002). Multivariate logistic regression analysis showed that in singleton infants, ureaplasma colonisation was the only independent (negative) predictor of RDS (OR 0.36; p=0.02). Both gestational age (OR 0.46; p=0.006) and isolation of U urealyticum (OR 3.0; p=0.05) were independent predictors of chronic lung disease (CLD), as defined by requirement for supplemental oxygen at 36 weeks of gestational age. Multiple gestation was also a major independent predictor of RDS and CLD. Conclusions-Colonisation or infection with ureaplasma apparently protects premature infants against the development of RDS (suggesting intrauterine infection). However, in singleton infants, it predisposes to development of CLD, independently of gestational age. Treatment of aVected infants after birth is unlikely to significantly improve the outcome and methods are required to identify and treat the women with intrauterine ureaplasmal infection, before preterm delivery occurs.

Experimental amniotic fluid infection in sheep: Effects of Ureaplasma parvum serovars 3 and 6 on preterm or term fetal sheep

“…Increased surfactant and lung compliance in preterm lambs exposed to ureaplasmas are consistent with data from human infants, which show a reduction in the risk of respiratory distress syndrome in the presence of airway (and likely antenatal) colonization (4,20). The clinical course of a group of infants with tracheal aspirate samples positive for Ureaplasma spp.…”

“…Ureaplasmas are the microorganisms most frequently associated with preterm birth (1)(2)(3), and their presence in amniotic fluid or the neonatal lungs influences an infant's risk of pulmonary disease (4,5). We demonstrated previously that intra-amniotic injection of Ureaplasma parvum serovar 3 results in amniotic and fetal pulmonary colonization, and induces functional 'maturation' of the preterm lungs in sheep (6).…”

Chorioamnionitis: a multiorgan disease of the fetus?

“…Ruptured membranes as surrogate for fetal infection, high concentrations of IL-6 in the cord blood as a sign for systemic inflammation 57 and colonization with Ureaplasma spp. 58 all independently predict a low risk for RDS. However, the Alabama Preterm Birth study further differentiated between the effects of histological chorioamnionitis (as reducing the risk of RDS) and the presence of ureaplasma/mycoplasma-positive cord blood cultures (as having no effect on RDS).…”

Nuclear Factor κB Activation in Pulmonary Leukocytes from Infants with Hyaline Membrane Disease: Associations with Chorioamnionitis and Ureaplasma urealyticum Colonization

“…We focused on pulmonary inflammatory cells and related NF-B activation to TNF-␣ and IL-8 levels in tracheal aspirates from these infants. Perinatal factors that may contribute to lung inflammation include chorioamnionitis (21,22) and Ureaplasma urealyticum colonization/infection of the airway (23)(24)(25)(26)(27). We determined whether these conditions are also associated with evidence of NF-B activation in the infant lung.…”