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Abstract
Objective
Ureaplasma has been demonstrated the cause of short and long-term morbidities of preterm infants, especially such as bronchopulmonary dysplasia (BPD). This study aims to evaluate the influence of Ureaplasma on neonatal morbidities and the effect of macrolide treatment in very low birth weight (VLBW) infants.
Methods
We performed a retrospective review of clinical records of VLBW infants born between 2015 and 2016. Their endotracheal aspirate and gastric juice were obtained immediately after birth and tested for Ureaplasma. Therapeutic macrolides were administered according to the clinical judgment, not routinely, in Ureaplasma-positive infants. Neonatal morbidities were compared using individual matching analysis between Ureaplasma-positive and negative groups, and with macrolides administration.
Results
A total of 144 infants with the mean (±standard deviation) gestational age of 28+3 (±3+3) weeks and birth weight of 1,051.9 (±290.0) g were included, and 30 (20.8%) were Ureaplasma-positive. Ureaplasma-positive group was associated with higher incidence of respiratory distress syndrome (RDS, P=0.039) and severe neurologic injury (SNI; intraventricular hemorrhage ≥grade 3 or periventricular leukomalacia, P=0.013). However, Ureaplasma-positive group was not associated with the risk of BPD (P=0.706). In the subgroup analysis for Ureaplasma-positive infants, there was no difference in the incidence of morbidities according to the macrolides administration.
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Table 1.
Demographic Characteristics
Values are presented as mean±standard deviation, mean (interquartile range), or number (%). Abbreviations: PROM, premature rupture of membranes; IUGR, intrauterine growth retardation; RDS, respiratory distress syndrome; PDA, patent ductus arteriosus; BPD, bronchopulmonary dysplasia; NEC, necrotizing enterocolitis; LOS, late-onset sepsis; ROP, retinopathy of prematurity; PMA, postmenstrual age.
Table 2.
Clinical Outcomes between Ureaplasma-Positive Infants and Matched Controls
| Ureaplasma-positive infants (n =27) | Controls (n=27) | P-value | |
|---|---|---|---|
| Gestational age (weeks) | 27.4±1.9 | 27.5±2.0 | 0.321 |
| Birth weight (g) | 1,028.5±277 | 1,030±273 | 0.667 |
| Male | 13 (48.1) | 13 (48.1) | 0.782 |
| Caesarean section | 13 (48.1) | 17 (63.0) | 0.412 |
| PROM | 22 (81.5) | 11 (40.7) | 0.007∗ |
| Histologic chorioamnionitis | 21 (77.8) | 21 (77.8) | 0.072 |
| Pre-eclampsia | 1 (3.7) | 2 (7.4) | 0.564 |
| RDS | 25 (92.6) | 18 (66.7) | 0.039∗ |
| PDA requiring treatment | |||
| Ibuprofen treatment | 11 (40.7) | 15 (55.6) | 0.206 |
| PDA ligation | 4 (14.8) | 6 (22.2) | 0.800 |
| Moderate to severe BPD | 12 (44.4) | 10 (37.0) | 0.706 |
| Severe BPD | 9 (33.3) | 7 (25.9) | 0.655 |
| Length of oxygen supply (days) | 83.9±81.7 | 68.7±62.7 | 7 0.430 |
| Duration of mechanical ventilation (days) | 43.8±44.8 | 42.4±43.6 | 6 0.155 |
| Duration of invasive ventilation (days) | 22.4±33.5 | 21.4±40.3 | 3 0.518 |
| Duration of noninvasive ventilation (days) | 21.4±21.1 | 21.0±18.9 | 9 0.497 |
| Postnatal steroid therapy | 8 (29.6) | 8 (29.6) | 1.000 |
| Cumulative dose of steroid (mg/kg) | 2.1±4.5 | 2.1±3.9 | 0.402 |
| Severe neurologic injury (IVH ≥grade 3 or PVL) | 5 (18.5) | 1 (3.7) | 0.013∗ |
| NEC (≥stage 2) | 3 (11.1) | 4 (14.8) | 0.706 |
| LOS | 8 (29.6) | 8 (29.6) | 0.763 |
| ROP requiring treatment | 6 (22.2) | 6 (22.2) | 0.317 |
| Hospital stay (days) | 96.0±76.5 | 83.5±57.5 | 0.550 |
| Mortality after 36 weeks of PMA | 1 (3.7) | 0 (0) | 0.254 |
Values are presented as mean±standard deviation or number (%). Abbreviations: PROM, premature rupture of membranes; RDS, respiratory distress syndrome; PDA, patent ductus arteriosus; BPD, bronchopulmonary dysplasia; IVH, intraventricular hemorrhage; PVL, periventricular leukomalacia; NEC, necrotizing enterocolitis; LOS, late-onset sepsis; ROP, retinopathy of prematurity; PMA, postmenstrual age.
Table 3.
Subgroup Analysis for Ureaplasma-Positive Infants According to Macrolide Treatment (n=30)
| Macrolide (n=14) | No macrolide (n=16) | P-value | |
|---|---|---|---|
| Gestational age (weeks) | 27.3±1.6 | 27.4±1.9 | 0.227 |
| Birth weight (g) | 1,030±261 | 1,022±267 | 0.078 |
| Male | 6 (42.9) | 9 (56.3) | 0.464 |
| Caesarean section | 8 (57.1) | 6 (37.5) | 0.706 |
| PROM | 10 (71.4) | 14 (87.5) | 0.383 |
| Histologic chorioamnionitis | 7 (50.0) | 14 (87.5) | 0.032 |
| RDS | 13 (92.9) | 15 (93.8) | 0.724 |
| PDA requiring treatment | |||
| Ibuprofen treatment | 8 (57.1) | 3 (18.8) | 0.029∗ |
| Ibuprofen treatment (≥2 times) | 5 (35.7) | 0 (0) | 0.012∗ |
| PDA ligation | 3 (21.4) | 3 (18.8) | 0.605 |
| Moderate to severe BPD | 8 (57.1) | 5 (31.3) | 0.153 |
| Severe BPD | 7 (50.0) | 5 (31.3) | 0.296 |
| Ventilator (days) | 53.5±53.0 | 33.0±31.1 | 0.169 |
| Length of oxygen supply (days) | 89.2±108 | 59.6±45.5 | 0.356 |
| Postnatal steroid therapy | 7 (50.0) | 4 (25.0) | 0.236 |
| Cumulative dose of steroid | 3.2±5.7 | 1.1±3.2 | 0.255 |
| Severe neurologic injury (IVH ≥grade | 3 (21.4) | 2 (12.5) | 0.642 |
| 3 or PVL) | |||
| NEC (≥stage 2) | 3 (21.4) | 0 (0) | 0.090 |
| LOS | 6 (42.9) | 4 (25.0) | 0.442 |
| ROP requiring treatment | 5 (35.7) | 2 (12.5) | 0.204 |
| Mortality after 36 weeks of PMA | 0 (0) | 1 (6.3) | 0.533 |
Values are presented as mean±standard deviation or number (%). Abbreviations: PROM, premature rupture of membranes; RDS, respiratory distress syndrome; PDA, patent ductus arteriosus; BPD, bronchopulmonary dysplasia; IVH, intraventricular hemorrhage; PVL, periventricular leukomalacia; NEC, necrotizing enterocolitis; LOS, late-onset sepsis; ROP, retinopathy of prematurity; PMA, postmenstrual age.
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