UREAPLASMA-UREALYTICUM AND CHRONIC LUNG-DISEASE IN VERY-LOW-BIRTH-WEIGHT INFANTS DURING THE EXOGENOUS SURFACTANT ERA

Background An association between recovery of Ureaplasma urealyticum f rom the respiratory tract of very low birth weight (VLBW) infants (les s than or equal to 1500 g) and later chronic lung disease (CLD) was re ported by several authors before the routine use of exogenous surfacta nt (SURF). We sought to assess whether this relation persists in the e ra of routine SURF. Methods. We prospectively studied a cohort of 105 VLBW infants who required mechanical ventilation at <12 h of age. Trac heal aspirates for U. urealyticum culture were obtained before adminis tration of SURF or antibiotics. Clinicians were unaware of U. urealyti cum status. Chest radiographs at 28 days were reviewed by a single ped iatric radiologist, blinded to U, urealyticum status. Sample size was predetermined to detect a 30% increase in CLD among those with U. urea lyticum recovery from tracheal culture (U. urealyticum-positive) with alpha < 0.05 and beta <0.20. Results. Of the study infants 22 were U, urealyticum-positive and 83 were U. urealyticum-negative. No differenc es were found between the groups for birth weight, gestational age, ge nder, inborn, antenatal or postnatal steroid use, SURF therapy, non-U. urealyticum infection, necrotizing enterocolitis, patent ductus arter iosus, intraventricular hemorrhage or cystic periventricular leukomala cia. At 28 days U. urealyticum-positive patients were significantly mo re 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 mecha nical 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. Conclusion s. Respiratory U. urealyticum at or shortly after birth remains associ ated with CLD at 28 days despite routine use of SURF. Controlled trial s of anti-Ureaplasma therapy in U. urealyticum-positive VLBWs as soon after birth as possible may determine whether CLD, duration of respira tory support and attendant costs can be decreased.