Bacteria passed on in the womb is linked to premature birth and breathing difficulties

September 13, 2018, European Lung Foundation

Babies born very prematurely are more likely to harbour Ureaplasma bacteria, according to new research to be presented on Sunday at the European Respiratory Society International Congress.

Ureaplasma are often present in the birth canal but they are unusually small and difficult to detect. The bacteria can be passed on to babies during pregnancy or birth, and can cause a respiratory infection in newborns.

The new research shows that very premature babies who have 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.

It also shows that a widely-available antibiotic that is effective against Ureaplasma in the lab can be given safely to premature babies and so could have a role in the of premature babies in the future.

The work was presented by Rose Marie Viscardi MD, Professor of Paediatrics at the University of Maryland School of Medicine, Baltimore. She says: "Research has already suggested a link between Ureaplasma infection, premature birth and a serious lung disease called bronchopulmonary dysplasia. 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 they're more likely to be re-admitted to hospital.

"I have been studying the association between Ureaplasma respiratory infection and bronchopulmonary dysplasia for more than 20 years. A key question is whether this bacteria is causing ill health in newborns and, if so, whether eliminating the bacteria improves outcomes for these very small babies."

Professor Viscardi studied a group of 121 babies born between 24 and 28 months' gestation (around six months). Half of the babies were treated with a three-day course of azithromycin (20 mg per kg of the baby's weight per day), while the other half were given a placebo. All were tested for the presence of Ureaplasma bacteria in their noses and windpipes before and after treatment, and followed up for their first year of life.

The researchers found that 36% of all the babies in the study were Ureaplasma-positive, but this rose to 45% among the most premature babies born between 24 and 26 weeks' gestation.

Compared to babies without the infection or those who only had the bacteria detected in their nose, these very premature babies who had Ureaplasma in their windpipe at birth were less likely to survive (71% compared to 90% and 100%), and they were more likely to develop bronchopulmonary dysplasia and other during their first year of life (67% compared to 50% and 21%).

The study suggests that the three-day course of azithromycin treatment was safe for these premature babies and effective at eradicating Ureaplasma bacteria.

The researchers caution that this is a small study, but say the results also show that the likelihood of death or severe respiratory disease one year after birth was lower in babies treated with azithromycin compared to babies who were Ureaplasma-positive and treated with placebo (33% compared to 86%).

Professor Viscardi added: "We believe that Ureaplasma bacteria can interact with a mother's and baby's immune defences leading to a chronic infection with persistent inflammation. This can then lead to premature labour or early rupture of the membranes. In a premature baby, inflammation alters the development of the immature lung, contributing to the development of bronchopulmonary dysplasia.

"This study shows that Ureaplasma respiratory infection is very common in extremely premature infants and clinicians should consider testing for this infection in those newborns who are at risk. It also suggests that the three-day course of azithromycin is safe and effective. However, there is not yet enough evidence to recommend routine treatment of Ureaplasma respiratory infection and we are planning a larger clinical trial to address this question."

Professor Viscardi and her team will continue to follow the babies in this study and hope to conduct a larger trial to show whether azithromycin treatment improves outcomes in the longer-term.

Professor Tobias Welte of Hannover University in Germany is President-Elect of the European Respiratory Society and was not involved in the study. He said: "There is currently 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 specialised lab tests. These bacteria are not considered dangerous in healthy people so many clinicians do not think treatment is necessary.

"However, this study suggests that in very premature this is linked with and a higher risk of death. Larger clinical trials are needed to clarify the importance of detecting Ureaplasma in and to show whether treatment with antibiotics is beneficial. Until then, antibiotic treatment should not be used routinely."

Explore further: Antibiotic may prove beneficial to preterm infant lung health

More information: Abstract no: OA301, "Azithromycin (AZM) reduces death or severe respiratory morbidity at 12 month adjusted age (AA) in Ureaplasma-positive intubated preterms.", R. Viscardi; Cell and molecular biology, General respiratory patient care, Physiology, Respiratory intensive care, 08:45 hrs CEST, Sunday 16 September, Paris Expo Porte de Versailles.

Related Stories

Antibiotic may prove beneficial to preterm infant lung health

April 26, 2011
A study performed by University of Kentucky researchers shows promise for the use of azithromycin in treating Ureaplasma-colonized or infected premature infants to prevent bronchopulmonary dysplasia (BPD).

Study shows heightened risks for premature babies in Bangladesh

March 21, 2018
A recently published study in Bangladesh titled Clinical outcome of the late preterm infants shows that premature babies can develop major neonatal complications that need admission in a neonatal intensive care unit.

Tests to bolster lung function later in life

May 4, 2015
Scientists have recommended a combination of lung function tests for prematurely born babies and children to help prevent the worsening of chronic respiratory disease throughout adulthood.

Variations in placental microbiota appear related to premature birth

May 18, 2018
A team of researchers from the United Kingdom has found a surplus of pathogenic bacteria in placentas from premature births, supporting the hypothesis that maternal infection may cause preterm birth. The research is published ...

Study of premature babies has implications for future treatment

July 11, 2017
Research carried out by the University with doctors on the neonatal unit at the William Harvey Hospital and Brunel University have provided further insight into the biology of premature birth, with findings that may have ...

Recommended for you

Study shows changes in histone methylation patterns in nutritionally stunted children

November 13, 2018
An international team of researchers has found changes in histone methylation patterns in nutritionally stunted children. In their paper published in Proceedings of the National Academy of Sciences, the group describes their ...

Your 6-month-old isn't sleeping through the night? Relax

November 12, 2018
(HealthDay)—If your 6-month-old still wakes up at 2 a.m., a new study suggests you don't lose any additional sleep worrying about it.

New exercise guidelines: Move more, sit less, start younger

November 12, 2018
Move more, sit less and get kids active as young as age 3, say new federal guidelines that stress that any amount and any type of exercise helps health.

Some activity fine for kids recovering from concussions, docs say

November 12, 2018
(HealthDay)—Children and teens who suffer a sports-related concussion should reduce, but not eliminate, physical and mental activity in the days after their injury, an American Academy of Pediatrics report says.

Soy formula feeding during infancy associated with severe menstrual pain in adulthood

November 9, 2018
New research suggests that infant girls fed soy formula are more likely to develop severe menstrual pain as young adults. The finding adds to the growing body of literature that suggests exposure to soy formula during early ...

A major role for a small organ in the immune response during pregnancy

November 9, 2018
The immune system of a pregnant woman is altered during pregnancy, but not in the way previously believed, according to results from a study at Linköping University, Sweden. This study, published in the Journal of Allergy ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.