Abstract
Microorganisms are hypothesized to contribute to the pathogenesis of bronchopulmonary dysplasia (BPD) in very low birth weight (VLBW) infants. This hypothesis remains controversial. We sought to determine whether endotracheal colonization with Ureaplasma sp., adenovirus, or Chlamydia sp. increases the risk of BPD. Intubated VLBW infants were included. Polymerase chain reaction (PCR) analysis was used to detect Ureaplasma sp., adenovirus, and Chlamydia sp. The outcome measure was BPD or death due to lung disease. Detection of microorganisms was compared between subjects with and without BPD. Logistic regression was used to control for covariates. Of 139 subjects, 33 (25%) screened positive for Ureaplasma sp., 22 of 136 (16%) were positive for adenovirus; eight of 133 (6%) were positive for Chlamydia sp. At 36 wk postmenstrual age, 14 patients had died, 68 (57%) had BPD. Detection of Ureaplasma sp. was associated with BPD or death (p < 0.001); adenovirus (p = 0.52) and Chlamydia sp. (p = 0.33) were not. Controlling confounding factors, the odds ratio for Ureaplasma sp. and BPD or death was 4.2 (95% CI 1.03, 17). In our population, detection of Ureaplasma sp., but not adenovirus or Chlamydia sp. was associated with BPD or death due to lung disease.
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Abbreviations
- BPD:
-
bronchopulmonary dysplasia
- EGA:
-
estimated gestational age
- PMA:
-
postmenstrual age
- VLBW:
-
very low birth weight
References
Bancalari E, Claure N, Sosenko IR 2003 Bronchopulmonary dysplasia: changes in pathogenesis, epidemiology and definition. Semin Neonatol 8: 63–71
Jobe AH, Bancalari E 2001 Bronchopulmonary dysplasia. Am J Respir Crit Care Med 163: 1723–1729
Northway WH Jr, Rosan RC, Porter DY 1967 Pulmonary disease following respirator therapy of hyaline-membrane disease. Bronchopulmonary dysplasia. N Engl J Med 276: 357–368
Charafeddine L, D'Angio CT, Phelps DL 1999 Atypical chronic lung disease patterns in neonates. Pediatrics 103: 759–765
Bancalari E, Gonzalez A 2000 Clinical course and lung function abnormalities during development of neonatal chronic lung disease. In: Bland RD, Coalson, JJ (eds) Chronic Lung Disease in Early Infancy. Marcel Dekker, New York, pp 41–64
Ohlsson A, Wang E, Vearncombe M 1993 Leukocyte counts and colonization with Ureaplasma urealyticum in preterm neonates. Clin Infect Dis 17: S144–S147
Panero A, Pacifico L, Rossi N, Roggini M, Chiesa C 1995 Ureaplasma urealyticum as a cause of pneumonia in preterm infants: analysis of the white cell response. Arch Dis Child Fetal Neonatal Ed 73: F37–F40
Groneck P, Goetze-Speer B, Speer CP 1996 Inflammatory bronchopulmonary response of preterm infants with microbial colonisation of the airways at birth. Arch Dis Child Fetal Neonatal Ed 74: F51–F55
Patterson AM, Taciak V, Lovchik J, Fox RE, Campbell AB, Viscardi RM 1998 Ureaplasma urealyticum respiratory tract colonization is associated with an increase in interleukin 1-beta and tumor necrosis factor alpha relative to interleukin 6 in tracheal aspirates of preterm infants. Pediatr Infect Dis J 17: 321–328
Lyon A 2000 Chronic lung disease of prematurity. The role of intra-uterine infection. Eur J Pediatr 159: 798–802
De Dooy JJ, Mahieu LM, Van Bever HP 2001 The role of inflammation in the development of chronic lung disease in neonates. Eur J Pediatr 160: 457–463
Groneck P, Schmale J, Soditt V, Stutzer H, Gotze-Speer B, Speer CP 2001 Bronchoalveolar inflammation following airway infection in preterm infants with chronic lung disease. Pediatr Pulmonol 31: 331–338
Colaizy TT, Kuforiji T, Sklar RS, Pillers DA 2003 PCR methods in clinical investigations of human ureaplasmas: a minireview. Mol Genet Metab 80: 389–397
Couroucli XI, Welty SE, Ramsay PL, Wearden ME, Fuentes-Garcia FJ, Ni J, Jacobs TN, Towbin JA, Bowles NE 2000 Detection of microorganisms in the tracheal aspirates of preterm infants by polymerase chain reaction: association of adenovirus infection with bronchopulmonary dysplasia. Pediatr Res 47: 225–232
Numazaki K, Chiba S, Kogawa K, Umetsu M, Motoya H, Nakao T 1986 Chronic respiratory disease in premature infants caused by Chlamydia trachomatis. J Clin Pathol 39: 84–88
Garland SM, Bowman ED 1996 Role of Ureaplasma urealyticum and Chlamydia trachomatis in lung disease in low birth weight infants. Pathology 28: 266–269
Da Silva O, Gregson D, Hammerberg O 1997 Role of Ureaplasma urealyticum and Chlamydia trachomatis in development of bronchopulmonary dysplasia in very low birth weight infants. Pediatr Infect Dis J 16: 364–369
Abele-Horn M, Peters J, Genzel-Boroviczeny O, Wolff C, Zimmermann A, Gottschling W 1997 Vaginal Ureaplasma urealyticum colonization: influence on pregnancy outcome and neonatal morbidity. Infection 25: 286–291
Sanchez PJ, Regan JA 1990 Vertical transmission of Ureaplasma urealyticum from mothers to preterm infants. Pediatr Infect Dis J 9: 398–401
Cassell GH, Waites KB, Crouse DT, Rudd PT, Canupp KC, Stagno S, Cutter GR 1988 Association of Ureaplasma urealyticum infection of the lower respiratory tract with chronic lung disease and death in very-low-birth-weight infants. Lancet 2: 240–245
Horowitz S, Landau D, Shinwell ES, Zmora E, Dagan R 1992 Respiratory tract colonization with Ureaplasma urealyticum and bronchopulmonary dysplasia in neonates in southern Israel. Pediatr Infect Dis J 11: 847–851
Payne NR, Steinberg SS, Ackerman P, Chrenka BA, Sane SM, Anderson KT, Fangman JJ 1993 New prospective studies of the association of Ureaplasma urealyticum colonization and chronic lung disease. Clin Infect Dis 17: S117–S121
Wang EE, Cassell GH, Sanchez PJ, Regan JA, Payne NR, Liu PP 1993 Ureaplasma urealyticum and chronic lung disease of prematurity: critical appraisal of the literature on causation. Clin Infect Dis 17: S112–S116
Iles R, Lyon A, Ross P, McIntosh N 1996 Infection with Ureaplasma urealyticum and Mycoplasma hominis and the development of chronic lung disease in preterm infants. Acta Paediatr 85: 482–484
Pacifico L, Panero A, Roggini M, Rossi N, Bucci G, Chiesa C 1997 Ureaplasma urealyticum and pulmonary outcome in a neonatal intensive care population. Pediatr Infect Dis J 16: 579–586
Abele-Horn M, Genzel-Boroviczeny O, Uhlig T, Zimmermann A, Peters J, Scholz M 1998 Ureaplasma urealyticum colonization and bronchopulmonary dysplasia: a comparative prospective multicentre study. Eur J Pediatr 157: 1004–1011
Hannaford K, Todd DA, Jeffery H, John E, Blyth K, Gilbert GL 1999 Role of Ureaplasma urealyticum in lung disease of prematurity. Arch Dis Child Fetal Neonatal Ed 81: F162–F167
Perzigian RW, Adams JT, Weiner GM, Dipietro MA, Blythe LK, Pierson CL, Faix RG 1998 Ureaplasma urealyticum and chronic lung disease in very low birth weight infants during the exogenous surfactant era. Pediatr Infect Dis J 17: 620–625
Smyth AR, Shaw NJ, Pratt BC, Weindling AM 1993 Ureaplasma urealyticum and chronic lung disease. Eur J Pediatr 152: 931–932
Saxen H, Hakkarainen K, Pohjavuori M, Miettinen A 1993 Chronic lung disease of preterm infants in Finland is not associated with Ureaplasma urealyticum colonization. Acta Paediatr 82: 198–201
Jonsson B, Karell AC, Ringertz S, Rylander M, Faxelius G 1994 Neonatal Ureaplasma urealyticum colonization and chronic lung disease. Acta Paediatr 83: 927–930
Heggie AD, Jacobs MR, Butler VT, Baley JE, Boxerbaum B 1994 Frequency and significance of isolation of Ureaplasma urealyticum and Mycoplasma hominis from cerebrospinal fluid and tracheal aspirate specimens from low birth weight infants. J Pediatr 124: 956–961
Heggie AD, Bar-Shain D, Boxerbaum B, Fanaroff AA, O'Riordan MA, Robertson JA 2001 Identification and quantification of ureaplasmas colonizing the respiratory tract and assessment of their role in the development of chronic lung disease in preterm infants. Pediatr Infect Dis J 20: 854–859
van Waarde WM, Brus F, Okken A, Kimpen JL 1997 Ureaplasma urealyticum colonization, prematurity and bronchopulmonary dysplasia. Eur Respir J 10: 886–890
Ollikainen J, Korppi M, Heiskanen-Kosma T, Heinonen K 2001 Chronic lung disease of the newborn is not associated with Ureaplasma urealyticum. Pediatr Pulmonol 32: 303–307
Cunliffe NA, Fergusson S, Davidson F, Lyon A, Ross PW 1996 Comparison of culture with the polymerase chain reaction for detection of Ureaplasma urealyticum in endotracheal aspirates of preterm infants. J Med Microbiol 45: 27–30
Abele-Horn M, Wolff C, Dressel P, Zimmermann A, Vahlensieck W, Pfaff F, Ruckdeschel G 1996 Polymerase chain reaction versus culture for detection of Ureaplasma urealyticum and Mycoplasma hominis in the urogenital tract of adults and the respiratory tract of newborns. Eur J Clin Microbiol Infect Dis 15: 595–598
Blanchard A, Hentschel J, Duffy L, Baldus K, Cassell GH 1993 Detection of Ureaplasma urealyticum by polymerase chain reaction in the urogenital tract of adults, in amniotic fluid, and in the respiratory tract of newborns. Clin Infect Dis 17: S148–S153
Hosmer DW Jr, Lemeshow S 2000 Applied Logistic Regression. John Wiley & Sons, New York,
Prosch S, Lienicke U, Priemer C, Flunker G, Seidel WF, Kruger DH, Wauer RR 2002 Human adenovirus and human cytomegalovirus infections in preterm newborns: no association with bronchopulmonary dysplasia. Pediatr Res 52: 219–224
Wang EE, Ohlsson A, Kellner JD 1995 Association of Ureaplasma urealyticum colonization with chronic lung disease of prematurity: results of a metaanalysis. J Pediatr 127: 640–644
Schelonka RL, Katz B, Waites KB, Benjamin DK Jr 2005 Critical appraisal of the role of Ureaplasma in the development of bronchopulmonary dysplasia with metaanalytic techniques. Pediatr Infect Dis J 24: 1033–1039
Nelson S, Matlow A, Johnson G, Th'ng C, Dunn M, Quinn P 1998 Detection of Ureaplasma urealyticum in endotracheal tube aspirates from neonates by PCR. J Clin Microbiol 36: 1236–1239
Teng K, Li M, Yu W, Li H, Shen D, Liu D 1994 Comparison of PCR with culture for detection of Ureaplasma urealyticum in clinical samples from patients with urogenital infections. J Clin Microbiol 32: 2232–2234
Acknowledgements
The authors thank Susan Escoe, Jiaqing Pang, Meena Mishra, Ian McMillan, Elaine Walker, and Spencer Watson for assistance in data collection and sample processing. They are grateful to unpublished contributions by Drs. Donald Buffkin, Vincent Koletar, and Theresa Kuforiji in identifying the importance of Ureaplasma in BPD in Oregon.
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This work was funded by NIH NRSA F32 (F32 HD0-44332) (T.T.C.), Northwest Health Foundation (D.M.P.), American Lung Association of Oregon (R.S.) and by a generous gift to the Doernbecher Children's Hospital Foundation in memory of a son, who died too young.
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Colaizy, T., Morris, C., Lapidus, J. et al. Detection of Ureaplasma DNA in Endotracheal Samples Is Associated With Bronchopulmonary Dysplasia After Adjustment for Multiple Risk Factors. Pediatr Res 61, 578–583 (2007). https://doi.org/10.1203/pdr.0b013e318045be03
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DOI: https://doi.org/10.1203/pdr.0b013e318045be03
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