Twenty percent of very preterm neonates (23-32 weeks of gestation) are born with bacteremia caused by genital Mycoplasmas

Abstract

Robert Goldenberg and the team at the University of Alabama report in this issue of the Journal that 23% of neonates who are born between 23 to 32 weeks of gestation have positive umbilical blood cultures for genital mycoplasmas (Ureaplasma urealyticum and Mycoplasma hominis).1Goldenberg R.L. Andrews W.W. Goepfert A.R. et al.The Alabama Preterm Birth Study: Umbilical cord blood Ureaplasma urealyticum and Mycoplasma hominis cultures in very preterm newborns.Am J Obstet Gynecol. 2008; (In press)Google Scholar Newborns with positive blood cultures had a higher frequency of a neonatal systemic inflammatory response syndrome, higher serum concentrations of interleukin-6 and more frequent histologic evidence of placental inflammation (chorioamnionitis and funisitis) than those with negative cultures.1Goldenberg R.L. Andrews W.W. Goepfert A.R. et al.The Alabama Preterm Birth Study: Umbilical cord blood Ureaplasma urealyticum and Mycoplasma hominis cultures in very preterm newborns.Am J Obstet Gynecol. 2008; (In press)Google Scholar See related article, page 43 See related article, page 43 These observations are important because they underscore that (1) 1 of every 4 preterm neonates (23-32 weeks of gestation) is born with fetal bacteremia, (2) genital mycoplasmas are a frequent cause of congenital fetal infection, and (3) U. urealyticum was the most frequent isolate. Simultaneous colonization with M. hominis and U. urealyticum was present in 22% of newborns with a positive umbilical blood culture. The article provides compelling evidence that congenital fetal infection is more frequent than was previously realized. The detection of genital mycoplasmas is not part of routine clinical practice in obstetrics and neonatology. Similarly, standard treatment for suspected neonatal sepsis does not include antibiotics that are effective against these microorganisms. Therefore, this report has important implications. The data used in the article were derived from the Alabama Preterm Birth Study, which was sponsored by the National Institute of Child Health and Human Development/National Institutes of Health. The study included 457 consecutive singleton pregnancies that delivered preterm between 23 and 32 weeks of gestation; 351 women/neonate pairs had umbilical cord blood cultures for genital mycoplasmas. Patients with spontaneous preterm delivery had a significantly higher rate of positive umbilical cord blood culture for U. urealyticum and/or M. hominis than those with indicated preterm delivery (34.7% vs 3.2%; P < .0001). The earlier the gestational age at delivery, the higher the rate of a positive umbilical cord blood culture. Neonates with a positive culture for U. urealyticum and/or M. hominis were more likely to have biochemical evidence of systemic inflammation, as determined by an elevated umbilical cord blood concentration of interleukin-6 (57.6% vs 19.7%; P < .0001), systemic inflammatory response syndrome (41.3% vs 25.7%; P = .007), and bronchopulmonary dysplasia (26.8% vs 10.1%; P = .0001). However, the association with bronchopulmonary dysplasia did not remain significant after adjusting for maternal race, gestational age at delivery, and neonatal gender. The initial uncertainties about whether genital mycoplasmas can cause fetal/neonatal disease are disappearing in light of the accumulating evidence that these microorganisms have been implicated in neonatal sepsis,2Kundsin R.B. Driscoll S.G. Monson R.R. Yeh C. Biano S.A. Cochran W.D. 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The Alabama Preterm Birth Study: Umbilical cord blood Ureaplasma urealyticum and Mycoplasma hominis cultures in very preterm newborn infantsAmerican Journal of Obstetrics & GynecologyVol. 198Issue 1PreviewThis study was undertaken to evaluate the frequency of umbilical cord blood infections with Ureaplasma urealyticum and Mycoplasma hominis in preterm 23- to 32-week births and to determine their association with various obstetric conditions, markers of placental inflammation, and newborn outcomes. Full-Text PDF