Lethal Neonatal Respiratory Failure by Perinatal Transmission of Ureaplasma Parvum after Maternal PPROM

Abstract

A primiparous pregnant woman was admitted due to preterm premature rupture of membranes (PPROM) at 27+0 week of gestational age (WGA). Conventional vaginal microbiological analysis had no pathological finding. Management decisions based on national guidelines included antenatal corticoids, tocolytics and antibiotics. Unstoppable efforts of preterm labor in 28+0 WGA and supposed amniotic infection syndrome necessitated emergency cesarean section. The preterm infant underwent NICU therapy, developed an early-onset neonatal sepsis and therapy-refractory pulmonary insufficiency with consecutive right heart failure, resulting in death on the 36^th day of life. Microbiota analyses by 16Sr DNA sequencing was performed from maternal vaginal swabs and from neonatal pharyngeal swabs. Maternal antibiotic treatment resulted in depletion of physiological vaginal colonization with Lactobacillus crispatus. Ureaplasma parvum became the dominant vaginal microorganism at delivery and was detected in high relative abundance in the neonatal specimen. Progressive radiological air-space changes and interstitial pathologies associated with Ureaplasma infection (bronchopulmonary dysplasia type III) were seen early at the 3^rd and distinctly from 14^th day of life. This clearly demonstrates the need of vaginal colonization diagnostics in PPROM patients and awareness of the consecutive risks in the preterm. Vaginal microbiome analysis may allow individualized and targeted maternal and fetal diagnostic, prophylactic and therapeutic strategies to identify, protect and treat the high-risk neonates after PPROM.

Zusammenfassung

Die Aufnahme erfolgte in der 27+0 Schwangerschaftswoche (SSW) aufgrund eines frühen vorzeitigen Blasensprunges (PPROM). Die konventionelle vaginale mikrobiologische Diagnostik verblieb unauffällig. Das Management umfasste leitliniengerecht die Applikation antenataler Steroide, Tokolytika und Antibiotika. Unaufhaltsame Frühgeburtsbestrebungen in der 28+0 SSW unter Verdacht eines Amnioninfektionssyndroms erforderten eine Notsectio. Das Frühgeborene erhielt eine sofortige NICU-Versorgung, entwickelte eine early-onset neonatale Sepsis und eine therapierefraktäre Lungen- mit konsekutiver Rechtsherzinsuffizienz, die zum Tod am 36. Lebenstag führte. Es wurden Mikrobiomanalysen mittels 16Sr DNA-Sequenzierung aus mütterlichen Vaginalabstrichen und aus neonatalen Rachenabstrichen durchgeführt. Die Antibiotikatherapie depletierte die physiologische vaginalen Kolonisation mit Lactobacillus crispatus. Ureaplasma parvum wurde als die dominierende vaginale mikrobielle Spezies und in den neonatalen Proben mit hoher relativer Abundanz nachgewiesen. Radiologisch wurden progressive Lungenveränderungen im Zusammenhang mit Ureaplasmen (bronchopulmonale Dysplasie Typ III) nachgewiesen. Dies zeigt deutlich die Notwendigkeit einer exakten vaginalen Kolonisationsdiagnostik bei PPROM-Patientinnen mit Relevanz für konsekutive Risiken bei Frühgeborenen. Die vaginale Mikrobiomanalyse kann dabei individualisierte mütterliche und neonatale diagnostische, prophylaktische und therapeutische Strategien zur Identifizierung, zum Schutz und zur Behandlung der Hochrisiko-Neugeborenen nach PPROM verbessern.

Key words

PPROM - EONS - Ureaplasma parvum - bronchopulmonary dysplasia - microbiome analysis

Schlüsselwörter

PPROM - EONS - Ureaplasma parvum - Bronchopulmonale Dysplasie - Mikrobiomanalyse

Publication History

Received: 28 July 2020

Accepted after revision: 19 November 2020

Article published online:
18 December 2020

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