617 - Association of Mycoplasma and Ureaplasma Respiratory Colonization with Bronchopulmonary Dysplasia and Neurodevelopmental Outcome in Extremely Preterm Infants- A Mediation Analysis

Poster Number: 617
Publication Number: 617.242

Background: Chorioamnionitis with Mycoplasma or Ureaplasma may predispose to very preterm birth, and frequently results in respiratory tract colonization in the infant. Extremely preterm (≤28 weeks gestational age, EP) infants with Mycoplasma and/or Ureaplasma respiratory colonization are at an increased risk of bronchopulmonary dysplasia (BPD). EP infants, especially with BPD are at higher risk of neurodevelopmental impairment (NDI). It is not evident if Mycoplasma or Ureaplasma colonization is an independently associated with BPD or NDI.

Objective: EP Infants with both Mycoplasma and Ureaplasma respiratory colonization will have the highest risk of developing BPD and NDI compared to either microbe alone in mediation analysis.

Design/Methods: EP infants admitted to UAB with respiratory (tracheal aspirate/nasopharyngeal) PCR and culture for Mycoplasma and Ureaplasma from January 01, 2014 to September 30, 2021 were included. Primary outcomes: BPD (≥Jensen’s grade 2) and death by 36 weeks corrected gestation, as well as severe neurodevelopmental impairment (Bayley’s Scale of Infant and Toddler Development 3rd edition) at 18-24 months. Severe NDI was defined as a Bayley-III cognitive composite score or motor composite score < 70, GMFCS level 4 or 5, bilateral blindness, or bilateral severe functional hearing impairment. We conducted mediation analysis on propensity score-matched case-control participants to explore the relationship between colonization and outcomes. Propensity score matching (1:1) was accomplished via logistic regression, incorporating gestational age, birth weight, race, sex, and antenatal corticosteroid exposure (caliper = 0.15).

Results: A total of 512 EP infants had culture assessment, of these all had BPD or death assessment at 36 weeks (159 BPD, 249 BPD/death(D) and 222 infants had death or neurodevelopmental assessment at 18-24 months (48 NDI, 119 NDI/D) (Figure 1). The mediation analysis showed that gestational age is associated with BPD, death, and NDI (95% CI, -0.15 to -0.05, p < 0.001) while colonization with either microbes or both had no significant association with BPD/death independent of gestational age (Figure 2). The colonization with both microbes was associated with an increased risk of NDI or death independent of gestational age (95%, CI -0.33 to -0.04, p < 0.05) (Figure 3).

Conclusion(s): The current study suggests that Mycoplasma and/or Ureaplasma respiratory colonization at birth is not associated with BPD or death by 36 weeks PMA. However, it indicates a potential association between colonization with both microbes and NDI and death.