Necrotizing enterocolitis is associated with ureaplasma colonization in preterm infants.
The study objective was to determine whether Ureaplasma respiratory tract colonization of preterm infants <33 wk gestation is associated with an increased risk for necrotizing enterocolitis (NEC). One or more tracheal or nasopharyngeal aspirates for Ureaplasma culture and PCR were obtained during the first week of life from 368 infants <33 wk gestation enrolled from 1999 to 2003 or from 2007 to 2009. NEC Bell stage ≥ 2 was confirmed by radiological criteria, and pathology, if available. Cord serum samples were analyzed for IL-6 and IL-1β concentrations, and placentas were reviewed for histological chorioamnionitis in the first cohort. NEC was confirmed in 29 of 368 (7.9%) of the combined cohorts. The incidence of NEC was 2.2-fold higher in Ureaplasma-positive (12.3%) than Ureaplasma-negative (5.5%) infants <33 wk (OR, 2.43; 95% CI, 1.13-5.2; p = 0.023) and 3.3-fold higher in Ureaplasma-positive (14.6%) than Ureaplasma-negative (4.4%) infants ≤ 28 wk (OR, 3.67; 95% CI, 1.36-9.93; p = 0.01). Age of onset, hematologic parameters at onset, and NEC severity were similar between Ureaplasma-positive and negative infants. Cord serum IL-6 and IL-1β concentrations were significantly higher in Ureaplasma-positive than in Ureaplasma-negative NEC-affected infants. Ureaplasma may be a factor in NEC pathogenesis in preterm infants by contributing to intestinal mucosal injury and/or altering systemic or local immune responses.
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
Adora C
AC
Okogbule-Wonodi
George W
GW
Gross
Chen-Chih J
CC
Sun
Alexander G
AG
Agthe
Li
L
Xiao
Ken B
KB
Waites
Rose Marie
RM
Viscardi
D000704:Analysis of Variance; D001431:Bacteriological Techniques; D015142:Baltimore; D016009:Chi-Square Distribution; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology*; D005260:Female; D005312:Fetal Blood / Q000276:immunology; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D018836:Inflammation Mediators / Q000097:blood; D053583:Interleukin-1beta / Q000097:blood; D015850:Interleukin-6 / Q000097:blood; D008297:Male; D016017:Odds Ratio; D016133:Polymerase Chain Reaction; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology*; D018570:Risk Assessment; D012307:Risk Factors; D014509:Ureaplasma / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity*; D016869:Ureaplasma Infections / Q000453:epidemiology / Q000276:immunology / Q000382:microbiology*
C508600:IL6 protein, human; D018836:Inflammation Mediators; D053583:Interleukin-1beta; D015850:Interleukin-6
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