Chronic lung disease of prematurity. The role of intra-uterine infection

Lyon, Andrew

doi:10.1007/s004310000587

Cited by 81 publications

(49 citation statements)

References 38 publications

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“…However, recent research has focused on the roles of perinatal infection and the inflammatory response as critical factors influencing chronic lung injury (7,16). Particular attention has been paid to the role of Ureaplasma species, fastidious bacteria found in the lower genital tracts of 40 to 80% of asymptomatic women (4).…”

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confidence: 99%

Characterization of Ureaplasmas Isolated from Preterm Infants with and without Bronchopulmonary Dysplasia

Katz¹,

Patel²,

Duffy³

et al. 2005

J Clin Microbiol

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A PCR assay was used to analyze endotracheal aspirates from preterm infants for Ureaplasma parvum versus U. urealyticum. U. parvum was detected more often than U. urealyticum. There was no significant difference or trend in the prevalence of either species between infants with or without bronchopulmonary dysplasia when isolated alone.The major factor leading to high morbidity and mortality of preterm infants is pulmonary immaturity. This manifests as respiratory distress in the early neonatal period and can develop into bronchopulmonary dysplasia (BPD), currently defined as a supplemental oxygen requirement at 36 weeks postmenstrual age, with characteristic radiographic findings (2). A recent survey reported that the incidence of BPD ranged from 67% among infants with birth weights of 500 to 750 g to Ͻ1% in infants weighing 1,250 to 2,500 g (2).Development of BPD is multifactorial and is related to pulmonary immaturity, oxidant injury due to high levels of inspired oxygen, and volutrauma associated with mechanical ventilation. However, recent research has focused on the roles of perinatal infection and the inflammatory response as critical factors influencing chronic lung injury (7, 16). Particular attention has been paid to the role of Ureaplasma species, fastidious bacteria found in the lower genital tracts of 40 to 80% of asymptomatic women (4). Rates of vertical transmission range from 18 to 88%, varying inversely with gestational age (6,8,12,24,25). Ureaplasma spp. are the most common microorganisms isolated from inflamed placentas and the lower respiratory tracts of neonates and are proven causes of neonatal pneumonia (4). Since initial reports associating ureaplasmal colonization and development of BPD were published in 1988 (5, 23, 26), more than 30 studies have been conducted. Most, but not all, have supported this association, despite major changes in the pulmonary management of very-low-birth-weight infants, such as exogenous surfactant, antenatal corticosteroid administration, and high frequency ventilation.

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mentioning

confidence: 99%

Characterization of Ureaplasmas Isolated from Preterm Infants with and without Bronchopulmonary Dysplasia

Katz¹,

Patel²,

Duffy³

et al. 2005

J Clin Microbiol

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“…The multifactorial etiology of BPD of the newborn has been reported over the last three decades (Bancalari et al, 2003;Jobe and Bancalari, 2001;Kinsella et al, 2006;Speer, 2003;Speer, 2006) With the increased survival of a greater number of more immature infants, the contribution of antenatal infection to BPD has been argued (Jobe, 2003;Lyon, 2000;Miralles et al, 2002). Ureaplasma spp.…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that development of BPD (CLD) is related to pulmonary immaturity, oxidant injury due to high levels of inspired oxygen, and volutrauma associated with mechanical ventilation. However, recent research has focused on the roles of perinatal infection and the inflammatory response as critical factors influencing chronic lung injury (De Dooy et al, 2001;Lyon, 2000). Particular attention has been given to the role of Ureaplasma species, found in the lower genital tracts of 40 to 80% of asymptomatic women (Cassell et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

Detection and biovar discrimination of Ureaplasma urealyticum colonization in preterm neonates under ventilation and correlation with bronchopulmonary dysplasia

El-Khier¹,

Megahed²,

Shokier³

2014

Afr. J. Microbiol. Res.

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Despite numerous studies, controversy regarding the association between Ureaplasma urealyticum colonization of premature neonates and bronchopulmonary dysplasia (BPD) still exists. The aim of the present study was to determine the colonization rate of preterm ventilated neonates with the two U. urealyticum biovars, parvo and T960, and to assess the correlation between colonization and the development of BPD. A prospective study was done from February 2013 to January 2014 in neonatal intensive care unit (NICU) in Mansoura University Children Hospital (MUCH) and NICU of different specialized medical centers, with 100 ventilated premature neonates (< 34 weeks) in the first 24 h of life, where tracheal secretions were aspirated, transported and cultured on 10B broth and A7 agar media. Culture was positive in 10 out of 85 samples (11.8%) as compared to 15/85 (17.6%) samples obtained by PCR technique. PCR assay demonstrated that Parva biovar (biovar 1) was the predominant, found in 9 (60%) out of 15 Ureaplasma isolates, as compared to T960 biovar (biovar 2) in 6 (40%) isolates. None of the neonates were cocolonized with both biovars. There was a statistically significant difference in the mean gestational age and mean birth weight between neonates with positive Ureaplasma colonization and neonates without colonization. BPD was significantly higher among colonized neonates than non-colonized one, 12 (80%) of 15 colonized neonates developed BPD as compared to 21 (30%) of 70 non colonized neonates. BPD was found to be correlated to decreasing gestational age (r = -0.341, p=0.001), low birth weight (r = -0.328, p= 0.002), and Ureaplasma colonization (r = 0.391, p < 0.001). Logistic regression analysis revealed that Ureaplasma colonization was a more important predictor for development of BPD than decreasing gestational age. BPD rate was higher among neonates colonized with T960 biovar (biovar 2) than those colonized with parvo biovar (biovar 1) (83.3% vs. 77.7%) with statistical significant difference (p = 0.001). colonization of respiratory tract by U. urealyticum, particularly biovar 2 (T960 biovar) in premature ventilated neonates was related to the development of BPD. PCR is a sensitive and specific technique for detecting Ureaplasma and for distinguishing its biovars (Parvum and T960) directly from clinical samples.

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“…In addition to causing the release of proinflammatory mediators, lung infection, either congenital or nosocomial, may result in the necessity for ventilatory support, which deteriorates pulmonary damage even further. 1,[14][15][16][17] Patent Ductus Arteriosus (PDA): PDA causes an increase in pulmonary blood flow and interstitial edema, reducing lung compliance and increasing airway resistance. This may result in a more aggressive and prolonged ventilatory strategy, elevating the risk for the development of BPD.…”

Section: Factors Associated With Lung Injurymentioning

confidence: 99%

Displasia broncopulmonar

Monte¹,

Filho²,

Miyoshi³

et al. 2005

J. Pediatr. (Rio J.)

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Objective: To present a wide-ranging review of the literature on bronchopulmonary dysplasia, covering new definitions, pathophysiology, prevention, treatment, prognosis and progression. Sources of data:The most relevant articles published on the subject since it was first described in 1967 were selected from MEDLINE search results. Summary of the findings:Bronchopulmonary dysplasia is considered one of the primary causes of chronic lung disease among infants. It is associated with frequent and prolonged hospital admissions, in particular for pulmonary diseases, with high rates of mortality and alterations to neuropsychomotor development and pondero-statural growth. Pathogenesis is complex, being primarily influenced by prematurity, infection, supplementary oxygen and mechanical ventilation. Prevention involves appropriate prenatal care, the prevention of premature delivery, prenatal corticosteroids, surfactant replacement therapy and protective ventilatory strategies. Treatment of bronchopulmonary dysplasia patients demands a multidisciplinary team. When indicated, oxygen supplementation is extremely important. Despite increased risk of morbidity and mortality during the first years of life, long term progress is favorable in the majority of cases.Conclusions: Bronchopulmonary dysplasia has been and continues to be studied in great depth with the objective of identifying its causes and possible prevention and treatment strategies. Controversies remain with respect of these issues and also about the prognosis of these patients, in particular when the subject is long-term progress of new bronchopulmonary dysplasia patients.J Pediatr (Rio J). 2005;81(2):99-110: Bronchopulmonary dysplasia, oxygen therapy, mechanical ventilation, corticosteroid, prevention, treatment, progression.

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Chronic lung disease of prematurity. The role of intra-uterine infection

Abstract: Intra-uterine infection is not only a common cause of preterm onset of labour but also a trigger to lung injury which significantly increases the risk of development of long-term respiratory disease in the newborn infant.

Cited by 81 publications

References 38 publications

Characterization of Ureaplasmas Isolated from Preterm Infants with and without Bronchopulmonary Dysplasia

Characterization of Ureaplasmas Isolated from Preterm Infants with and without Bronchopulmonary Dysplasia

Detection and biovar discrimination of Ureaplasma urealyticum colonization in preterm neonates under ventilation and correlation with bronchopulmonary dysplasia

Displasia broncopulmonar

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