Perzigian R W, Adams J T, Weiner G M, Dipietro M A, Blythe L K, Pierson C L, Faix R G
Department of Pediatrics, The University of Michigan Medical Center, Ann Arbor 48109-0254, USA.
Pediatr Infect Dis J. 1998 Jul;17(7):620-5. doi: 10.1097/00006454-199807000-00009.
An association between recovery of Ureaplasma urealyticum from the respiratory tract of very low birth weight (VLBW) infants (< or =1500 g) and later chronic lung disease (CLD) was reported by several authors before the routine use of exogenous surfactant (SURF). We sought to assess whether this relation persists in the era of routine SURF.
We prospectively studied a cohort of 105 VLBW infants who required mechanical ventilation at < 12 h of age. Tracheal aspirates for U. urealyticum culture were obtained before administration of SURF or antibiotics. Clinicians were unaware of U. urealyticum status. Chest radiographs at 28 days were reviewed by a single pediatric radiologist, blinded to U. urealyticum status. Sample size was predetermined to detect a 30% increase in CLD among those with U. urealyticum recovery from tracheal culture (U. urealyticum-positive) with alpha <0.05 and beta <0.20.
Of the study infants 22 were U. urealyticum-positive and 83 were U. urealyticum-negative. No differences were found between the groups for birth weight, gestational age, gender, inborn, antenatal or postnatal steroid use, SURF therapy, non-U. urealyticum infection, necrotizing enterocolitis, patent ductus arteriosus, intraventricular hemorrhage or cystic periventricular leukomalacia. At 28 days U. urealyticum-positive patients were significantly more likely to have CLD than U. urealyticum-negative [15 of 22 (68%) vs. 30 of 83 (36%); P < 0.02]. The U. urealyticum-positive patients also required significantly longer courses of supplemental oxygen and mechanical ventilation. No significant differences were found for CLD at 36 weeks postconception or duration of hospitalization, although type II error could not be excluded for these secondary endpoints.
Respiratory U. urealyticum at or shortly after birth remains associated with CLD at 28 days despite routine use of SURF. Controlled trials of anti-Ureaplasma therapy in U. urealyticum-positive VLBWs as soon after birth as possible may determine whether CLD, duration of respiratory support and attendant costs can be decreased.
在常规使用外源性表面活性剂（SURF）之前，已有多位作者报道极低出生体重（VLBW）婴儿（≤1500g）呼吸道解脲脲原体的恢复与后期慢性肺病（CLD）之间存在关联。我们试图评估在常规使用SURF的时代这种关系是否仍然存在。
我们前瞻性研究了105例出生后12小时内需要机械通气的VLBW婴儿队列。在给予SURF或抗生素之前获取气管吸出物进行解脲脲原体培养。临床医生不知道解脲脲原体的状态。由一名对解脲脲原体状态不知情的儿科放射科医生对28天时的胸部X光片进行评估。样本量预先确定，以检测气管培养物中解脲脲原体恢复阳性的婴儿中CLD增加30%（解脲脲原体阳性），α<0.05，β<0.20。
在研究婴儿中，22例解脲脲原体阳性，83例解脲脲原体阴性。两组在出生体重、胎龄、性别、足月儿、产前或产后使用类固醇、SURF治疗、非解脲脲原体感染、坏死性小肠结肠炎、动脉导管未闭、脑室内出血或脑室周围白质软化方面没有差异。在28天时，解脲脲原体阳性患者患CLD的可能性显著高于解脲脲原体阴性患者[22例中的15例（68%）对83例中的30例（36%）；P<0.02]。解脲脲原体阳性患者还需要显著更长疗程的补充氧气和机械通气。在孕36周时CLD或住院时间方面未发现显著差异，尽管这些次要终点不能排除II类错误。
尽管常规使用SURF，但出生时或出生后不久呼吸道解脲脲原体仍与28天时的CLD相关。对出生后尽早解脲脲原体阳性的VLBW婴儿进行抗解脲脲原体治疗的对照试验可能确定是否可以降低CLD、呼吸支持时间和相关费用。
