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We evaluated respiratory outcomes associated with early\n                      <jats:italic>Ureaplasma<\/jats:italic>\n                      positivity in VLBW infants and assessed feasibility and preliminary efficacy of a standardized intravenous azithromycin regimen in a nested pilot randomized trial.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single-center study comprised (1) a retrospective cohort of inborn VLBW infants (&lt;\u20091,500\u00a0g) born between July 2017 and December 2021 who underwent\n                      <jats:italic>Ureaplasma<\/jats:italic>\n                      screening within 24\u00a0h after birth, and (2) a prospective, double-blind, randomized, placebo-controlled pilot trial nested among\n                      <jats:italic>Ureaplasma<\/jats:italic>\n                      -positive infants requiring significant respiratory support. In the cohort, outcomes included moderate-to-severe and severe BPD at 36 weeks\u2019 postmenstrual age and home oxygen therapy. Multivariable logistic regression adjusted for gestational age, sex, preterm premature rupture of membranes, histologic chorioamnionitis, antenatal steroid exposure, patent ductus arteriosus treatment, and sepsis. In the trial, infants were randomized 1:1 to intravenous azithromycin for 14 days (10\u00a0mg\/kg\/day for 7 days, then 5\u00a0mg\/kg\/day for 7 days) or placebo. Microbiologic response at 2 weeks and safety, including QTc, were assessed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 536 VLBW infants, 34 (6.3%) were\n                      <jats:italic>Ureaplasma<\/jats:italic>\n                      positive.\n                      <jats:italic>Ureaplasma<\/jats:italic>\n                      -positive infants had higher rates of moderate-to-severe BPD (76.5% vs. 41.0%), severe BPD (67.6% vs. 36.0%), and home oxygen therapy (46.2% vs. 19.1%). After adjustment,\n                      <jats:italic>Ureaplasma<\/jats:italic>\n                      positivity remained associated with moderate-to-severe BPD (adjusted odds ratio [aOR] 3.86, 95% confidence interval [CI] 1.44\u201310.35) and severe BPD (aOR 2.93, CI 1.21\u20137.10). In the pilot trial (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200926; 13 per group), moderate-to-severe BPD occurred in 61.5% (8\/13) with azithromycin versus 84.6% (11\/13) with placebo, and severe BPD in 46.2% (6\/13) versus 76.9% (10\/13). Loss of detectable\n                      <jats:italic>Ureaplasma<\/jats:italic>\n                      by culture at 2 weeks occurred in 13\/13 azithromycin-treated infants, while 5\/13 placebo infants remained positive. No QTc prolongation or clinically significant safety concerns attributable to azithromycin were observed.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      Early\n                      <jats:italic>Ureaplasma<\/jats:italic>\n                      positivity in VLBW infants was associated with substantially worse respiratory outcomes. A two-week intravenous azithromycin regimen was feasible, microbiologically active, and showed directionally favorable estimates for BPD without an observed safety signal. Larger microbiology-guided trials are warranted.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>KCT0002373 (registered 7 July 2017).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12887-026-07199-2","type":"journal-article","created":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T07:56:07Z","timestamp":1783065367000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ureaplasma positivity and respiratory outcomes in very low birth weight infants: a cohort study with a nested double-blind randomized pilot trial of azithromycin"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0693-5627","authenticated-orcid":false,"given":"Euiseok","family":"Jung","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0221-7784","authenticated-orcid":false,"given":"Geun Mi","family":"Park","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9905-6519","authenticated-orcid":false,"given":"Chae Young","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8788-929X","authenticated-orcid":false,"given":"Jeong Min","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0217-1773","authenticated-orcid":false,"given":"Ha Na","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3363-1162","authenticated-orcid":false,"given":"Jiyoon","family":"Jeong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5920-7354","authenticated-orcid":false,"given":"Soo Hyun","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1347-4200","authenticated-orcid":false,"given":"Byong Sop","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9859-3021","authenticated-orcid":false,"given":"Ellen Ai-Rhan","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1547-5220","authenticated-orcid":false,"given":"Ki-Soo","family":"Kim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"issue":"1","key":"7199_CR1","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1038\/s41572-019-0127-7","volume":"5","author":"B Th\u00e9baud","year":"2019","unstructured":"Th\u00e9baud B, Goss KN, Laughon M, Whitsett JA, Abman SH, Steinhorn RH, et al. 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