Bowman E D, Dharmalingam A, Fan W Q, Brown F, Garland S M
Department of Pediatrics, The Royal Women's Hospital, Carlton, Victoria, Australia.
Pediatr Infect Dis J. 1998 Jul;17(7):615-20. doi: 10.1097/00006454-199807000-00008.
Chronic lung disease (CLD) is a significant cause of neonatal morbidity and mortality despite advances in neonatal care. Ureaplasma urealyticum colonization of the lower respiratory tract has been associated with CLD, particularly in extremely low birth weight infants. Despite numerous studies demonstrating the pathogenicity of this organism, treatment remains controversial. This study examines neonates colonized with U. urealyticum in the lower respiratory tract and treated with erythromycin, as compared with noncolonized neonates.
A prospective cohort study of 124 neonates weighing <1000 g at birth, requiring endotracheal intubation and ventilation. Endotracheal aspirates were cultured for U. urealyticum and conventional bacteria twice weekly for the duration of endotracheal intubation. Infants colonized with U. urealyticum were treated with intravenous erythromycin. Maximal ventilatory requirements, CLD at Day 28 and 36 weeks postconception, duration of ventilation, oxygen dependency and hospital stay were documented.
Twenty-two infants (18%) were identified as being U. urealyticum colonized in endotracheal aspirates. Colonization was significantly associated with younger maternal age, prolonged rupture of membranes, premature labor and vaginal delivery. Of colonized neonates 14% were delivered by cesarean section, with intact membranes. As compared with noncolonized infants, there were no statistically significant differences in chronic lung disease, duration of oxygen therapy or time to discharge.
Seven published cohort studies of similar high risk populations where U. urealyticum-colonized infants did not receive erythromycin therapy, show a consistent association with CLD (pooled relative risk + 5.21; 95% confidence interval, 2.93 to 9.64). This association was not demonstrated in the current study and adds further weight to the need for a randomized controlled trial to be performed to evaluate this treatment regimen.
尽管新生儿护理取得了进展，但慢性肺部疾病（CLD）仍是新生儿发病和死亡的重要原因。解脲脲原体在下呼吸道的定植与CLD有关，尤其是在极低出生体重儿中。尽管众多研究表明该病原体具有致病性，但治疗仍存在争议。本研究将下呼吸道被解脲脲原体定植并接受红霉素治疗的新生儿与未被定植的新生儿进行比较。
对124例出生体重<1000g、需要气管插管和机械通气的新生儿进行前瞻性队列研究。在气管插管期间，每周两次对气管内吸出物进行解脲脲原体和常规细菌培养。被解脲脲原体定植的婴儿接受静脉注射红霉素治疗。记录最大通气需求、孕28周和36周时的CLD、通气时间、氧依赖情况和住院时间。
22例婴儿（18%）的气管内吸出物被鉴定为解脲脲原体定植。定植与母亲年龄较小、胎膜早破时间延长、早产和阴道分娩显著相关。在被定植的新生儿中，14%通过剖宫产分娩，胎膜完整。与未被定植的婴儿相比，慢性肺部疾病、氧疗时间或出院时间在统计学上没有显著差异结论：七项已发表的针对类似高危人群的队列研究中，被解脲脲原体定植的婴儿未接受红霉素治疗，结果显示与CLD存在一致关联（合并相对风险+5.21；95%置信区间，2.93至9.64）。本研究未证实这种关联，这进一步表明需要进行一项随机对照试验来评估这种治疗方案。
