Integrated placental and neonatal urinary detection of Ureaplasma urealyticum: A translational approach to predicting adverse neonatal outcomes.

INTRODUCTION

Ureaplasma urealyticum (U. urealyticum) commonly colonizes the maternal genital tract and contributes to intrauterine infection. However, the clinical relevance of U. urealyticum detection in neonatal urine, particularly in conjunction with placental colonization, remains poorly defined. This study evaluates the association of U. urealyticum detection in neonatal urine and placenta with inflammatory responses and adverse outcomes in preterm births.

METHODS

This retrospective cohort included 227 neonates born between January 2020 and December 2022 at Jinan Maternal and Child Health Hospital. U. urealyticum was detected by PCR in neonatal urine and paraffin-embedded placental tissues. Clinical data, histologic maternal and fetal inflammatory response, and adverse neonatal outcomes (e.g., sepsis, severe pneumonia, bronchopulmonary dysplasia, brain injury, gastrointestinal bleeding/perforation, myocardial injury, death) were analyzed.

RESULTS

U. urealyticum was detected in 34.4 % of neonatal urine and 22.5 % of placental specimens. Urinary positivity was associated with lower gestational age (≤28 weeks), vaginal delivery, preterm premature rupture of membranes, and higher rates of severe neonatal complications (24.4 % vs. 8.7 %, p = 0.0013). The positivity rates of U. urealyticum in both urine and placenta increased with advancing maternal and fetal inflammatory responses stages (p < 0.001). A moderate association was observed between urine and placental positivity (φ = 0.311, p < 0.001). The Dual-site detection of U. urealyticum was associated with the highest neonatal complication rate (28.1 %), suggesting a cumulative effect.

DISCUSSION: Combined detection of U. urealyticum in neonatal urine and placenta identifies preterm infants at highest risk of adverse outcomes and may aid early risk stratification.