Neonatal central nervous system infection by Ureaplasma species is rare, but relevant: results from a multicenter nationwide surveillance study

Purpose: Ureaplasma species (spp.) are relevant contributors to preterm birth but may also cause invasive infections particularly in very immature preterm infants. This study aimed to assess the incidence of neonatal Ureaplasma infections of the central nervous system (CNS).

Methods: A nationwide epidemiological study on Ureaplasma CNS infection in preterm and term neonates and infants below 12 months of age was conducted between 10/2019 and 09/2022, using the German Pediatric Surveillance Unit (ESPED).

Results: Over a period of three years, five infants with Ureaplasma meningitis were reported, amended by three cases treated in our own hospital. All infants had a history of extreme preterm birth. Clinical presentation varied and included non-specific neurological symptoms, such as developmental delay, in some cases, and acute, sepsis-like conditions in others, with increased apneas, irritability, and seizures. As the most consistent finding, internal hydrocephalus was reported, paralleled by pathological cerebrospinal fluid assessment characterized by mild pleocytosis, persistently elevated protein levels, and remarkably low or undetectable glucose levels, prompting further diagnostics. Treatment protocols varied and included off-label regimens. Ureaplasma eradication was verified by negative CSF-PCR and/or culture in most cases. Despite successful eradication, long-term neurological impairment was present in all infants.

Conclusion: Although seemingly rare, Ureaplasma-driven neuroinflammation relevantly contributes to long-term morbidity of affected preterm infants.