title: Gastric fluid versus amniotic fluid analysis for the identification of intra-amniotic infection due to Ureaplasma species.
abstract: OBJECTIVE
  Early neonatal sepsis is often due to intra-amniotic infection. The stomach of the neonate contains fluid swallowed before and during delivery. The presence of bacteria as well as neutrophils detected by culture or Gram stain of the gastric fluid during the first day of life is suggestive of exposure to bacteria or inflammation. We undertook this study to determine the relationship between gastric fluid analysis and amniotic fluid obtained by transabdominal amniocentesis in the detection of Ureaplasma species, the most frequent microorganisms responsible for intra-amniotic infection.
  
  
  METHODS
  The study population consisted of 100 singleton pregnant women who delivered preterm neonates (<35 weeks) within 7 days of amniocentesis. Gastric fluid of newborns was obtained by nasogastric intubation on the day of birth. Amniotic fluid and gastric fluid were cultured for genital Mycoplasmas, and polymerase chain reaction (PCR) for Ureaplasma species was performed. Intra-amniotic inflammation was defined as an elevated amniotic fluid matrix metalloproteinase-8 concentration (>23 ng/mL).
  
  
  RESULTS
  (1) Ureaplasma species were detected by culture or PCR in 18% (18/100) of amniotic fluid samples and in 5% (5/100) of gastric fluid samples; (2) among the amniotic fluid cases positive for Ureaplasma species, these microorganisms were identified in 27.8% (5/18) of gastric fluid samples; (3) none of the cases negative for Ureaplasma species in the amniotic fluid were found to be positive for these microorganisms in the gastric fluid; (4) patients with amniotic fluid positive for Ureaplasma species but with gastric fluid negative for these microorganisms had a significantly higher rate of intra-amniotic inflammation, acute histologic chorioamnionitis, and neonatal death than those with both amniotic fluid and gastric fluid negative for Ureaplasma species; and (5) no significant differences were observed in the rate of intra-amniotic inflammation, acute histologic chorioamnionitis, and neonatal death between patients with amniotic fluid positive for Ureaplasma species but with gastric fluid negative for these microorganisms and those with both amniotic fluid and gastric fluid positive for Ureaplasma species.
  
  
  CONCLUSIONS
  Gastric fluid analysis has 100% specificity in the identification of intra-amniotic infection with Ureaplasma species. However, the detection of Ureaplasma species by culture or PCR in the gastric fluid of neonates at birth did not identify these microorganisms in two-thirds of cases with microbial invasion of the amniotic cavity. Thus, amniotic fluid analysis is superior to that of gastric fluid in the identification of intra-amniotic infection.
authors.affiliation: a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea .|b Department of Obstetrics and Gynecology , Seoul Metropolitan Government-Seoul National University Boramae Medical Center , Seoul , Republic of Korea .
authors.forename: Sun Min
authors.initials: SM
authors.lastname: Kim
authors.affiliation: c Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit , Michigan , USA .|d Department of Obstetrics and Gynecology , University of Michigan , Ann Arbor , Michigan , USA .|e Department of Epidemiology and Biostatistics , Michigan State University , East Lansing , Michigan , USA .|f Center for Molecular Medicine and Genetics, Wayne State University , Detroit , Michigan , USA , and.
authors.forename: Roberto
authors.initials: R
authors.lastname: Romero
authors.affiliation: a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea .
authors.forename: JoonHo
authors.initials: J
authors.lastname: Lee
authors.affiliation: c Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit , Michigan , USA .|g Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , Michigan , USA.
authors.forename: Piya
authors.initials: P
authors.lastname: Chaemsaithong
authors.affiliation: c Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, and Detroit , Michigan , USA .|g Department of Obstetrics and Gynecology , Wayne State University School of Medicine , Detroit , Michigan , USA.
authors.forename: Nikolina
authors.initials: N
authors.lastname: Docheva
authors.affiliation: a Department of Obstetrics and Gynecology , Seoul National University College of Medicine , Seoul , Republic of Korea .
authors.forename: Bo Hyun
authors.initials: BH
authors.lastname: Yoon
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000201:enzymology / Q000382:microbiology*; D001826:Body Fluids / Q000382:microbiology*; D002821:Chorioamnionitis / Q000382:microbiology* / Q000473:pathology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000382:microbiology* / Q000401:mortality; D020784:Matrix Metalloproteinase 8 / Q000032:analysis; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis; D013270:Stomach / Q000382:microbiology*; D014509:Ureaplasma / Q000302:isolation & purification; D016869:Ureaplasma Infections / Q000382:microbiology*
chemical_list: D020784:Matrix Metalloproteinase 8
keywords: Acute histologic chorioamnionitis; amniocentesis; culture; gastric aspirate; genital Mycoplasmas; matrix metalloproteinase-8; neonatal sepsis; preterm birth