Does Ureaplasma spp. cause chronic lung disease of prematurity: ask the audience?

Abstract

Ureaplasma has long been implicated in the pathogenesis of both preterm labour and neonatal morbidity, particularly chronic lung disease of prematurity (CLD), but despite numerous studies, reviews and meta-analyses, its exact role remains unclear. Many papers call for a definitive randomised control trial to determine if eradication of pulmonary Ureaplasma decreases the rates of CLD but few address in detail the obstacles to an adequately powered clinical trial. We review the evidence for Ureaplasma as a causative agent in CLD, asking why a randomised control trial has not been performed. We surveyed the opinions of senior neonatologists in the UK on whether they felt that there was sufficient evidence for Ureaplasma either causing or not causing CLD and whether a definitive trial was needed, as well as their views on the design of such a trial. Additionally, we ascertained current practice with respect to Ureaplasma detection in preterm neonates in the UK. There is clear support for an adequately powered randomised controlled clinical trial by senior neonatologists in the UK. There are no reasons why a definitive trial cannot be conducted especially as the appropriate samples, and methods to culture or identify the organism by PCR are already available.

Fig. 1

Clinicians' opinion of whether Ureaplasma causes CLD or not.

Fig. 2

Clinician estimates of colonisation with Ureaplasma in infants born at less than 28 weeks gestation.

Fig. 3

Whether clinicians routinely tested or would be interested in an affordable test for identifying Ureaplasma.

Fig. 4

Frequency of local testing and nature of sample sent for identifying Ureaplasma as well as how often Ureaplasma is seen in their own units.

Fig. 5

Clinicians' opinion of what drug should be used in a clinical trial to test if eradication of Ureaplasma decreases the rates of CLD.