In utero exposure to Ureaplasma spp. and risk of BPD and IVH in preterm infants

The pathogenesis of bronchopulmonary dysplasia (BPD) is multifactorial and includes also infection, inflammation from ventilator-induced mechanical injury and oxidant stress. Ureaplasma spp. are the most frequently isolated microorganisms inside the amniotic cavity during pregnancy and have been associated with preterm labor and preterm premature rupture of membrane. Recent data suggest that the pro-inflammatory response triggered by these microorganisms can lead to an increased risk of BPD and severe intraventricular hemorrhage (IVH). However, the topic is still controversial.
On these bases, an Austrian group has evaluated the association between short-term neonatal morbidities, such as BPD and IVH, and Ureaplasma spp infection. The study enrolled 257 preterm infants born by cesarean section at <34 weeks' gestation. Patients were divided into two groups according to detection of Ureaplasma spp. by culture-based and/or polymerase chain reaction (PCR) techniques.
Significant differences were observed between groups for all IVH (P=0.032) and IVH grades III or IV (P=0.013), as wells as for BPD (OR: 5.46, 95% CI: 2.02–14.77), oxygen requirement at 28 days postnatal age (OR: 1.93, 95% CI: 1.00–3.70), and for death between 28 days and 36 postmenstrual weeks or BPD (OR: 4.20, 95% CI: 1.77–9.96). Multi-variable analysis showed Ureaplasma spp. to be a significant predictor (P<0.001) of BPD after correcting for birth weight (P=0.003) and positive pressure ventilation (P=0.001).
These findings confirm a robust association between invasion of the amniotic cavity with Ureaplasma spp. and the risk of BPD and IVH in preterm infants. Prospective multi-center studies including prevention strategies and antibiotic therapy, with multiple sample points (amniotic cavity, placental and endotracheal) are needed for a better understanding of the impact of Ureaplasma spp. in the morbidity and mortality of newborn patients.

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