Gastric fluid versus amniotic fluid analysis for the identification of intra-amniotic infection due toUreaplasmaspecies

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 in 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. Materials and Methods The study population consisted of 100 singleton pregnant women who delivered preterm neonates (<35weeks) 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 (> 23ng/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.

Gastric fluid used to assess changes during the latency period in preterm prelabor rupture of membranes

“…The observation from paired samples used in a recent study showed a lower rate of Ureaplasma species in gastric fluid samples at the time of delivery than in amniotic fluid samples at the time of admission. 27 This conflicts with the results in our study. We found a higher rate of Ureaplasma species in gastric fluid than in amniotic fluid.…”

“…25,26 Ureaplasma species are also the most common bacteria in gastric fluid. 27 Similar to previous observations in amniotic fluid and maternal or umbilical cord blood, the intensity of inflammatory response in gastric fluid to Ureaplasma species was dose-dependent. [28][29][30][31] This suggests that bedside IL-6 assessment of gastric fluid samples positive for Ureaplasma species might be useful in predicting the microbial burden.…”

Bronchopulmonary Dysplasia andUreaplasma: What Do We Know So Far?

“…There was no significant difference if both amniotic fluid and gastric fluid were tested positive 22) .…”

“…Recently, a study analyzed gastric fluid versus amniotic fluid of preterm infants for the identification of intra uterine infec tions 22) .…”

Initial microbial community of the neonatal stomach immediately after birth

“…In previous studies using culture based techniques, gastric fluid collected immediately after birth identified Ureaplasma species was also present in amniotic fluid, with high specificity but low sensitivity 12 In addition, cytokines present in gastric fluid aspirated immediately after delivery have been associated with chorioamnionitis (indicating placental inflammation) and funisitis (indicating fetal inflammation). 13 In this pilot study, we present for the first time fluid samples from gastric aspirate collected within an hour of birth from both term and pre-term infants for analysis of microbes.…”