早产婴儿常常受到各种的胎儿或新生儿疾病的致命威胁。2008年1月的爱思唯尔期刊《美国产科学与妇科医学杂志》(American Journal of Obstetrics & Gynecology)上的一篇文章报道,阿拉巴马大学伯明翰医学院和德雷塞尔大学医学院的科学家发现,生殖道支原体是引起胎儿先天细菌感染的常见原因。怀孕23至32周后出生的早产儿中,23%从脐带血中检测出感染了两种生殖道支原体:解脲支原体和人型支原体。
尽管80%的孕妇的阴道和子宫分泌物中都存在解脲支原体和人型支原体,但并不是这些孕妇所生产的婴儿都会感染。研究中发现四分之一的早产婴儿出生时就已经感染了支原体。相比那些未受感染的新生儿,这些受感染的新生婴儿患婴儿全身性炎症反应综合症、支气管肺发育不良的几率更高,白细胞介素-6血清浓度更高,胎盘炎症发病率也更高。早产婴儿中,对应妊娠期越短,支原体感染检测呈阳性的机率越高。
该研究调查了“阿拉巴马州早产研究”项目中1996年至2001年的连续性457例早产单胎案例,共发现351例脐带血支原体(解脲支原体和人型支原体)检测呈阳性的母婴案例。
德雷塞尔大学医学院妇产科学系教授、医学博士Robert Goldenberg在文章中写道:“考虑到婴儿先天支原体感染的几率以及可能导致全身性炎症反应综合症和支气管肺发育不良,理所应当对新生婴儿进行支原体感染检测,并对检测呈阳性的婴儿进行相应的抗生素治疗。由此我们自然提出一个新的问题:对可能发生早产的孕妇进行针对这两种支原体的抗生素治疗是否会降低婴儿病发率和死亡率呢?”
在另一篇相关社论中,美国国家儿童卫生与人类发展研究所(NICHD/NIH)围产期学研究分支主任和项目主管,韦恩州立大学分子产科学和遗传学教授,医学博士Roberto Romero和加利福尼亚大学妇产科学系名誉教授,医学博士Thomas J. Garite发表评论说:“这篇文章明白地表明婴儿先天细菌感染比我们从前以为的多。现在生殖道支原体检测还不是常规临床妇产检查的内容。对疑似脓血症婴儿的常规治疗自然也就不包括针对支原体的抗生素治疗。”
Romero 和 Garite进一步指出:“最初大家只是怀疑生殖道支原体是否会引起胎儿/新生儿疾病。但随着生殖道支原体导致新生儿脓血症、肺炎、脑膜炎和脑部病变的病例不断出现,可以确认这就是罪魁祸首。新生儿呼吸系统感染支原体还有可能诱发慢性肺部疾病。” (科学网 荔涛/编译)
生物谷推荐原始出处:
American Journal of Obstetrics and Gynecology
Volume 198, Issue 1, January 2008, Pages 43.e1-43.e5
The Alabama Preterm Birth Study: Umbilical cord blood Ureaplasma urealyticum and Mycoplasma hominis cultures in very preterm newborn infants
Robert L. Goldenberg MDa, William W. Andrews PhD, MDb, Alice R. Goepfert MDb, Ona Faye-Petersen MDc, Suzanne P. Cliver BSb, Waldemar A. Carlo MDd and John C. Hauth MDb
aDepartment of Obstetrics and Gynecology, Drexel University College of Medicine, Philadelphia, PA
bDepartment of Obstetrics and Gynecology, University of Alabama–Birmingham Medical School, Birmingham, AL
cDepartment of Pathology, University of Alabama–Birmingham Medical School, Birmingham, AL
dDepartment of Pediatrics, University of Alabama–Birmingham Medical School, Birmingham, AL.
Received 14 March 2007; revised 30 May 2007; accepted 23 July 2007. Available online 31 December 2007.
Objective
This 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.
Study Design
351 mother/infant dyads with deliveries between 23 and 32 weeks’ gestational age who had cord blood cultures for U urealyticum and M hominis had their medical records abstracted, other placental cultures performed, cord interleukin-6 levels determined, placentas evaluated histologically, and infant outcomes determined.
Results
U urealyticum and/or M hominis were present in 23% of cord blood cultures. Positive cultures were more common in infants of nonwhite women (27.9% vs 16.8%; P = .016), in women less than 20 years of age, in those undergoing a spontaneous compared to an indicated preterm delivery (34.7% vs 3.2%; P = .0001), and in those delivering at earlier gestational ages. Intrauterine infection and inflammation were more common among infants with a positive U urealyticum and M hominis culture as evidenced by placental cultures for these and other bacteria, elevated cord blood interleukin-6 levels, and placental histology. Infants with positive cord blood U urealyticum and M hominis cultures were more likely to have neonatal systemic inflammatory response syndrome (41.3% vs 25.7%; P = .007; adjusted odds ratio, 1.86; 1.08-3.21) and probably bronchopulmonary dysplasia (26.8% vs 10.1%; P = .0001; adjusted odds ratio 1.99; 0.91-4.37), but were not significantly different for other neonatal outcomes, including respiratory distress syndrome, intraventricular hemorrhage, or death.
Conclusion
U urealyticum and M hominis cord blood infections are far more common in spontaneous vs indicated preterm deliveries and are strongly associated with markers of acute placental inflammation. Positive cultures are associated with neonatal systemic inflammatory response syndrome and probably bronchopulmonary dysplasia.
Key words: bronchopulmonary dysplasia; Mycoplasma hominis; neonatal outcome; neonatal systemic inflammatory response syndrome; placental histology; preterm birth; umbilical cord blood; Ureaplasma urealyticum
Cite this article as: Goldenberg RL, Andrews WW, Goepfert AR, et al. The Alabama Preterm Birth Study: Umbilical cord blood Ureaplasma urealyticum and Mycoplasma hominis cultures in very preterm newborn infants. Am J Obstet Gynecol 2008;198:43.e1-43.e5.Reprints not available from the authors.Funded by the NICHD PERC grant (HD 33927).