Jung Euiseok, Choi Chang Won, Kim Su Yeong, Sung Tae-Jung, Kim Haeryoung, Park Kyoung Un, Kim Han-Suk, Kim Beyong Il, Choi Jung-Hwan
Department of Pediatrics, Asan Medical Center Children's Hospital, Seoul, Korea.
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
Pediatr Int. 2017 Jan;59(1):34-40. doi: 10.1111/ped.13072. Epub 2016 Sep 6.
Both histologic chorioamnionitis (HCAM) and Ureaplasma infection are considered important contributors to perinatal lung injury. We tested the hypothesis that coexistence of maternal HCAM and perinatal Ureaplasma exposure increases the risk of prolonged mechanical ventilation in extremely low-birthweight (ELBW) infants.
A retrospective cohort study was carried out of all ELBW infants born between January 2008 and December 2013 at a single academic center. Placental pathology and gastric fluid Ureaplasma data were available for all infants. Culture and polymerase chain reaction were used to detect Ureaplasma in gastric fluid. Prolonged mechanical ventilation was defined as mechanical ventilation that began within 28 days after birth and continued.
Of 111 ELBW infants enrolled, 84 survived beyond 36 weeks of postmenstrual age (PMA) and were included in the analysis. Eighteen infants (21.4%) had both HCAM and Ureaplasma exposure. Seven infants (8.3%) required mechanical ventilation beyond 36 weeks of PMA. Coexistence of HCAM and Ureaplasma in gastric fluid was significantly associated with prolonged mechanical ventilation after adjustment for gestational age, sex, mode of delivery, and use of macrolide antibiotics (OR, 8.7; 95%CI: 1.1-67.2).
Coexistence of maternal HCAM and perinatal Ureaplasma exposure significantly increases the risk of prolonged mechanical ventilation in ELBW infants.
组织学绒毛膜羊膜炎（HCAM）和脲原体感染均被认为是围产期肺损伤的重要促成因素。我们检验了这样一个假设，即母亲HCAM与围产期脲原体暴露并存会增加极低出生体重（ELBW）婴儿长时间机械通气的风险。
对2008年1月至2013年12月在单一学术中心出生的所有ELBW婴儿进行了一项回顾性队列研究。所有婴儿都有胎盘病理学和胃液脲原体数据。采用培养和聚合酶链反应检测胃液中的脲原体。长时间机械通气定义为出生后28天内开始并持续的机械通气。
在纳入研究的111例ELBW婴儿中，84例在孕龄（PMA）36周后存活并纳入分析。18例婴儿（21.4%）同时患有HCAM和脲原体暴露。7例婴儿（8.3%）在PMA 36周后需要机械通气。在对胎龄、性别、分娩方式和大环内酯类抗生素使用情况进行调整后，胃液中HCAM和脲原体的并存与长时间机械通气显著相关（比值比，8.7；95%置信区间：1.1 - 67.2）。
母亲HCAM与围产期脲原体暴露并存显著增加了ELBW婴儿长时间机械通气的风险。
