Effects of Antenatal Azithromycin for Ureaplasma spp. on Neonatal Outcomes

Keun Hyeok Ko; Ji Young Chun; Tae-Jung Sung

doi:10.14734/PN.2018.29.01.01

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Ko, Chun, and Sung: Effects of Antenatal Azithromycin for Ureaplasma spp. on Neonatal Outcomes

Original Article

Perinatology 2018;29(1):1-7.

Published online: 19 March 2018

DOI: https://doi.org/10.14734/PN.2018.29.01.01

Effects of Antenatal Azithromycin for Ureaplasma spp. on Neonatal Outcomes

Keun Hyeok Ko, MD, Ji Young Chun, MD, Tae-Jung Sung, MD, PhD

Department of Pediatrics, Hallym University Medical Center, Seoul, Korea

Correspondence to Tae-Jung Sung, MD, PhD Department of Pediatrics, Hallym University Medical Center, 1 Singil-ro, Yeongdeunpo-gu, Seoul 07441, Korea Tel: +82-2-829-5142 Fax: +82-2-849-4469 E-mail: neosung@hallym.or.kr

Received 15 September 201710 October 2017 Accepted 21 October 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Ureaplasma spp. in the maternal genitourinary tract is increasingly known to cause preterm labor, spontaneous abortion, chorioamnionitis and adverse neonatal outcomes. However, controversies still remain regarding whether or not to treat it aggressively. The aim of this study was to evaluate the effects of antenatal azithromycin (AZ) for Ureaplasma urealyticum (UU) infection on neonatal complications in preterm infants.

Methods

Retrospective single-center case-control study of preterm babies delivered at <32 weeks’ of gestation age (GA) between 2010 and 2014 were conducted. Cases were defined as infants with complete maternal AZ treatment when UU was confirmed and controls were without UU. Cases were matched with controls by birth year, GA, and birth weight. Subgroup analysis according to GA (23⁺⁰28⁺⁶ weeks’ and 29⁺⁰-32⁺⁶ weeks’) were done as well.

Results

Of 169 cases identified 51 with untreated or incompletely treated mother, 26 died or transferred, and four with incomplete chart were excluded; thus 88 preterm infants were matched to 88 controls. Incidence of bronchopulmonary dysplasia (BPD) and early sepsis were same in both group; however, in very preterm infants between 23⁺⁰ to 28⁺⁶ weeks’ GA, incidence of moderate-to-severe BPD was significantly higher in cases (42% vs. 16%, P=0.022) and incidence of sepsis was significantly lower (8% vs. 26%, P=0.033).

Conclusion

Maternal UU was associated with moderate-to-severe BPD even though AZ treatment was done. Early sepsis was significantly less developed with prenatal antibiotics at ≤28 weeks’ GA. Hence selective antenatal azithromycin therapy of UU is still needed for improving neonatal outcomes.

Keywords: Cervical Cerclage, Cervical length measurement, Uterine cervical incompetence, Premature birth

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Table 1.

The Demographics and Clinical Characteristics of Study Population

	Cases (n=88)	Controls (n=88)	P-value
Gestational age (wks)	28.8±2.3	28.8±2.3	1.000
Birth weight (g)	1,349.5±402.5	1,321.9±381.8	0.641
Apgar score at 1 minute	3.9±2.0	4.0±1.8	0.720
Apgar score at 5 minute	6.1±1.7	6.1±1.8	1.000
Length of stay (days)	60.5±30.1	61.2±29.3	0.873
Duration of use of ventilation (days)	11.8±18.5	15.4±27.1	0.298
Duration of oxygen supplement (days)	25.6±32.8	26.3±34.7	0.892
Primipara (%)	20 (22.7)	29 (33.0)	0.178
PPROM (%)	42 (47.7)	38 (43.2)	0.545
Preterm labor (%)	76 (86.4)	68 (77.3)	0.171
Antenatal steroids (%)	80 (90.9)	77 (87.5)	0.466
Chorioamnionitis
Clinical (%)	41 (46.6)	38 (43.2)	0.649
Histologic (%)	35 (50.0)	30 (49.2)	0.925

Values presented as mean±standard deviation or n (%). Abbreviation: PROM, preterm premature rupture of membrane.

Table 2.

Comparison of Neonatal Morbidities between Infants with Antenatal Azithromycin Treated Group and Antenatal UU-Negative Groups

	Cases (n=88)	Controls (n=88)	P-value
Surfactant use	49 (55.7)	53 (60.2)	0.541
29⁺⁰-32⁺⁶ week	14 (28.0)	16 (32.0)	0.828
23⁺⁰-28⁺⁶ week	35 (92.1)	37 (97.4)	0.304
BPD	31 (35.2)	38 (43.2)	0.280
29⁺⁰-32⁺⁶ week	2 (4.0)	7 (14.0)	0.160
23⁺⁰-28⁺⁶ week	29 (76.3)	31 (81.6)	0.779
Moderate-to-severe BPD	16 (18.2)	6 (6.8)	0.038
29⁺⁰-32⁺⁶ week	0	0
23⁺⁰-28⁺⁶ week	16 (42.1)	6 (15.8)	0.022
PDA with medication±operation	11 (12.5)	17 (19.3)	0.303
29⁺⁰-32⁺⁶ week	1 (2.0)	2 (4.0)	1.000
23⁺⁰-28⁺⁶ week	10 (26.3)	15 (39.5)	0.329
ROP with laser treatment	12 (13.6)	14 (16.3)	0.675
29⁺⁰-32⁺⁶ week	0	0
23⁺⁰-28⁺⁶ week	12 (31.6)	14 (36.8)	0.809
NEC (≥stage IIA)	4 (4.5)	1 (1.1)	0.368
29⁺⁰-32⁺⁶ week	1 (2.0)	0	1.000
23⁺⁰-28⁺⁶ week	3 (7.9)	1 (2.6)	0.615
Early sepsis	8 (9.1)	13 (14.8)	0.353
29⁺⁰-32⁺⁶ week	5 (10.0)	3 (6.0)	0.715
23⁺⁰-28⁺⁶ week	3 (7.9)	10 (26.3)	0.033
IVH (≥grade 3)±PVL	6 (6.8)	10 (11.4)	0.432
29⁺⁰-32⁺⁶ week	1 (2.0)	3 (6.0)	0.617
23⁺⁰-28⁺⁶ week	5 (13.2)	7 (18.4)	0.754

Values are presented as number (%). Abbreviations: UU, Ureaplasma urealyticum; BPD, bronchopulmonary dysplasia; PDA, patent ductus arteriosus; ROP, retinopathy of prematurity; NEC, necrotizing enterocolitis; IVH, intraventricular hemorrhage; PVL, periventricular leukomalacia.

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