New antibiotic regimen for preterm premature rupture of membrane reduces the incidence of bronchopulmonary dysplasia

Tanaka, Satoko; Tsumura, Keisuke; Nakura, Yukiko; Tokuda, Tsugumichi; Nakahashi, Hiroaki; Yamamoto, Takakazu; Ono, Takeshi; Yanagihara, Itaru; Nomiyama, Makoto

doi:10.1111/jog.13903

Cited by 17 publications

(14 citation statements)

References 34 publications

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“…It eliminated Ureaplasma spp. from the amniotic fluid and reduced IL‐6 levels in patients with pPROM . In addition, a meta‐analysis showed that the administration of interleukin (IL)‐6 to preterm infants significantly reduced the incidence of bronchopulmonary dysplasia with a risk ratio of 0.86 (95% confidence interval (CI): 0.77–0.97) .…”

Section: Therapeutic Options For Genital Ureaplasma Infection In Pregmentioning

confidence: 99%

“…In addition, a meta‐analysis showed that the administration of interleukin (IL)‐6 to preterm infants significantly reduced the incidence of bronchopulmonary dysplasia with a risk ratio of 0.86 (95% confidence interval (CI): 0.77–0.97) . We previously proposed a new regimen using ampicillin–sulbactam and azithromycin for pPROM treatment to reduce the incidence of bronchopulmonary dysplasia in infants . However, U. urealyticum isolates obtained from Chinese patients showed a resistance rate of 17.7% against azithromycin .…”

Section: Therapeutic Options For Genital Ureaplasma Infection In Pregmentioning

confidence: 99%

“…However, intra‐amniotic infection and inflammation were not resolved in all patients treated with ampicillin/amoxicillin and erythromycin . Another study involving patients with pPROM between 22 and 27 weeks of gestation suggested that the use of ampicillin–sulbactam and azithromycin improves perinatal outcomes …”

Section: Antibiotic Regimen For Intra‐amniotic Infection With Ureaplamentioning

confidence: 99%

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Current understanding and treatment of intra‐amniotic infection with Ureaplasma spp.

Tantengco

Yanagihara

2019

J of Obstet and Gynaecol

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Considerable evidence has shown that intra-amniotic infection with Ureaplasma spp. increases the risk of chorioamnionitis and preterm labor. Ureaplasma spp. are among the smallest organisms, and their isolation is uncommon in routine clinical practice because of their size and high auxotrophy. Although Ureaplasma spp. have been reported as causative agents of preterm birth, they also have a high incidence in vaginal swabs collected from healthy reproductive-age women; this has led to questions on the virulence of Ureaplasma spp. and to them being considered as harmless commensal bacteria. Therefore, many efforts have been made to clarify the pathogenicity of Ureaplasma spp. at the molecular level. Ureaplasma spp. are surrounded by lipoproteins, including multiple-banded antigen. Both multiple-banded antigen and its derivative, that is, the synthetic lipopeptide, UPM-1, induce an inflammatory response in a preterm mice model, which was adequate to cause preterm birth or stillbirth. In this review, we present an overview of the virulence mechanisms of Ureaplasma spp. and treatment of ureaplasma infection during pregnancy to prevent possible serious sequelae in infants. In addition, relevant mechanisms underlying antibiotic resistance in Ureaplasma spp. are discussed. Ureaplasma spp. are naturally resistant against β-lactam antibiotics because of the lack of a cell wall. Azithromycin is one of the effective agents that can control intrauterine ureaplasma infection. In fact, macrolide-and fluoroquinolone-resistant isolates of Ureaplasma spp. have already been observed in perinatal practice in Japan.

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Section: Therapeutic Options For Genital Ureaplasma Infection In Pregmentioning

confidence: 99%

Section: Therapeutic Options For Genital Ureaplasma Infection In Pregmentioning

confidence: 99%

Section: Antibiotic Regimen For Intra‐amniotic Infection With Ureaplamentioning

confidence: 99%

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Current understanding and treatment of intra‐amniotic infection with Ureaplasma spp.

Tantengco

Yanagihara

2019

J of Obstet and Gynaecol

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“…20 However, animal experiments have shown that AZM prolongs the period of time from PPROM to delivery compared to erythromycin 21 and that in humans it reduces the incidence rate of bronchopulmonary dysplasia. 22 Therefore, we divided these cases into one group administered with SBT/ABPC+AZM and one group administered with other antimicrobial agents.…”

Section: Methodsmentioning

confidence: 99%

Continuous amnioinfusion for treatment of mid‐trimester preterm premature rupture of membranes with oligoamnios

Ono

Tsumura

Kawasaki

et al. 2019

J of Obstet and Gynaecol

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Aim Given the scarcity of relevant reports, this study aimed to elucidate whether pregnancy can be prolonged by maintaining the amniotic fluid volume with continuous transabdominal amnioinfusion (TA) for patients with mid‐trimester preterm premature rupture of membranes (PPROM) and oligoamnios. Methods We retrospectively examined patients who were managed during hospitalization at our department after developing PPROM between week 22 day 0 and week 25 day 6 of gestation and subsequent oligoamnios (amniotic fluid index [AFI] <5 cm) within 7 days after PPROM onset. Cases between 2006 and 2011 comprised the conventional management group (n = 14); cases administered continuous TA between 2012 and 2017 comprised the continuous TA group (n = 14). The primary outcome was the number of days between PPROM and delivery. The secondary outcomes were the proportion of normal amniotic fluid volume (AFI ≥ 5 cm) maintained between PPROM and delivery and the perinatal prognosis for the mother and infant. Results The continuous TA group had significantly more days between PPROM and delivery and a significantly higher proportion of days that a normal amniotic fluid volume was maintained during that period, regardless of antimicrobial agents administered. Although no significant differences in the perinatal prognosis of disease were found between groups, there was a decreasing trend of composite perinatal mortality and morbidity, and the incidence rates were reduced by half. Conclusion Continuous TA for PPROM with oligoamnios may allow significant prolongation of the gestation period while maintaining the amniotic fluid volume and may lead to improved perinatal prognosis.

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“…Some studies suggest that macrolides have beneficial short-term effects on lung disease of prematurity. Given the prevalence of ureaplasma species in chorioamnionitis and its suspected role in BPD, adding azithromycin to the standard antibiotic regimen in women with PPROM <28 weeks of gestation improves perinatal respiratory outcomes and the BPD risk [136]. However, the lasting impact of the microbiome is still poorly understood, and potentially significant.…”

Section: Impact Of Antibiotic Exposurementioning

confidence: 99%

Nutrients and Microbiota in Lung Diseases of Prematurity: The Placenta-Gut-Lung Triangle

et al. 2020

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Cardiorespiratory function is not only the foremost determinant of life after premature birth, but also a major factor of long-term outcomes. However, the path from placental disconnection to nutritional autonomy is enduring and challenging for the preterm infant and, at each step, will have profound influences on respiratory physiology and disease. Fluid and energy intake, specific nutrients such as amino-acids, lipids and vitamins, and their ways of administration —parenteral or enteral—have direct implications on lung tissue composition and cellular functions, thus affect lung development and homeostasis and contributing to acute and chronic respiratory disorders. In addition, metabolomic signatures have recently emerged as biomarkers of bronchopulmonary dysplasia and other neonatal diseases, suggesting a profound implication of specific metabolites such as amino-acids, acylcarnitine and fatty acids in lung injury and repair, inflammation and immune modulation. Recent advances have highlighted the profound influence of the microbiome on many short- and long-term outcomes in the preterm infant. Lung and intestinal microbiomes are deeply intricated, and nutrition plays a prominent role in their establishment and regulation. There is an emerging evidence that human milk prevents bronchopulmonary dysplasia in premature infants, potentially through microbiome composition and/or inflammation modulation. Restoring antibiotic therapy-mediated microbiome disruption is another potentially beneficial action of human milk, which can be in part emulated by pre- and probiotics and supplements. This review will explore the many facets of the gut-lung axis and its pathophysiology in acute and chronic respiratory disorders of the prematurely born infant, and explore established and innovative nutritional approaches for prevention and treatment.

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New antibiotic regimen for preterm premature rupture of membrane reduces the incidence of bronchopulmonary dysplasia

Cited by 17 publications

References 34 publications

Current understanding and treatment of intra‐amniotic infection with Ureaplasma spp.

Current understanding and treatment of intra‐amniotic infection with Ureaplasma spp.

Continuous amnioinfusion for treatment of mid‐trimester preterm premature rupture of membranes with oligoamnios

Nutrients and Microbiota in Lung Diseases of Prematurity: The Placenta-Gut-Lung Triangle

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