PracticeUpdate Conference Series: ERS 2018

Bacteria Passed From Uterus to Fetus Linked to Premature Birth and Breathing Difficulty Babies born very prematurely aremore likely to harbor Ureaplasma bacteria passed from the mother’s uterus.

V ery premature babies who harbor Ureaplasma bacteria in the lungs at birth are more likely to develop respiratory problems during their first year of life and less likely to survive. A 3-day course of azithromycin has been shown to be safe for these premature babies and effective at eradicating Ureaplasma bacteria, outcome of a placebo-controlled study show. Rose Marie Viscardi, MD, of the University of Maryland School of Medicine in Baltimore, said in an ERS press release, “Research has already suggested a link between Ureaplasma infection, premature birth, and bronchopulmonary dyspla- sia. Prematurely born babies with this condition may have long-term breathing problems such as asthma, and they may require oxygen at home, respiratory medications, more doctor visits, and hospital readmission.” She continued, “I have been studying the associ- ation between Ureaplasma respiratory infection and bronchopulmonary dysplasia for more than 20 years. A key question is whether this bacteria causes ill health in newborns and, if so, whether eliminating the bacteria improves outcomes for these very small babies.” Dr. Viscardi told Elsevier’s PracticeUpdate, “The primary goal of the study was to determine whether the 3-day course of azithromycin was safe and eradicated Ureaplasma bacteria effectively in affected preterm babies.” Dr. Viscardi and colleagues studied a group of 121 babies born between 24 and 28 months’ gestation (approximately 6 months). Half of the babies were treated with a 3-day course of azithromycin (20 mg per kg of the baby’s weight per day), and the other half were given placebo. All were tested for the presence of Ureaplasma bacteria in the nose and windpipe before and after treatment, and followed for their first year of life. Overall, 36% of the babies were Ureaplasma - positive. This percentage rose to 45% among the most premature babies born between 24 and 26 weeks’ gestation. Compared with babies without the infection or those who harbored the bacteria detected only in the nose, these very premature babies who harbored Ureaplasma in the windpipe at birth were less likely to survive (71% vs 90% and 100%, respectively).

They were more likely to develop bronchopul- monary dysplasia and other respiratory problems during their first year of life (67% vs 50% and 21%, respectively). Dr. Viscardi told Elsevier’s PracticeUpdate, “The study showed that preterm babies at highest risk for adverse outcomes such as death and respira- tory problems after birth and in the first year of life are the most preterm babies, born before 27 weeks’ gestation (13 weeks before due date). Such babies harbor Ureaplasma detected in the lungs. This high-risk group may benefit from azithromycin treatment.” The researchers cautioned that this was a small study. The results, however, also showed that the likelihood of death or severe respiratory disease 1 year after birth was lower in babies treated with azithromycin than in those who were Ureaplasma - positive and treated with placebo (33% vs 86%). Dr. Viscardi added, “We believe that Ureaplasma bacteria can interact with a mother’s and baby’s immune defenses, leading to chronic infection with persistent inflammation. This can then lead to premature labor or early rupture of membranes. In a premature baby, inflammation alters the devel- opment of the immature lung, contributing to the development of bronchopulmonary dysplasia." She cautioned, “This study showed that Ureaplasma respiratory infection is very common in extremely premature infants. Clinicians should consider testing for this infection in newborns at risk. It also suggested that the 3-day course of azith- romycin was safe and effective. Sufficient evidence has not accrued, however, to recommend routine treatment of Ureaplasma respiratory infection. We plan a larger clinical trial to address this question.” Dr. Viscardi and her team will continue to follow the babies through 2 years of age and hope to conduct a larger trial to determine whether azithromycin treatment improves outcomes in the longer-term. TobiasWelte, MD, of Hannover University inGermany, was not involved in the study. He remarked in an ERS press release, “There is no consensus among neonatal specialists on whether to test for Ureaplasma , or whether to give treatment if the bacteria are detected. Ureaplasma are not picked up by routine tests for infections and require spe- cialized lab tests. These bacteria are not considered dangerous in healthy people so many clinicians do not think treatment is necessary.”

Dr. Rose Marie Viscardi

www.practiceupdate.com/c/73729

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