Severe Intracranial Hemorrhage and Intracranial Infection Caused by Ureaplasma parvum Infection in an Extremely Preterm Infant: A Case Report and Literature Review

Abstract Background:Ureaplasma parvum (Up) is an under-recognized pathogen in neonatal central nervous system infections. We retrospectively analyzed the clinical data of one extremely preterm infant presenting with severe intracranial hemorrhage (ICH) and intracranial infection attributed to Up infection, and systematically reviewed the relevant literature. The analysis covered perinatal history, neurological manifestations, serial cerebrospinal fluid (CSF) and imaging changes, metagenomic next-generation sequencing (mNGS) results, and treatment course. Case presentation:A male infant was born at 26⁺¹ weeks of gestation with a birth weight of 920 g. Intracranial hemorrhage, initially grade I on day 1 of life, progressed to grade IV by day 4. CSF examination showed typical features of intracranial infection: the nucleated cell count was markedly elevated, glucose was profoundly decreased (0.07 mmol/L), and protein reached 7,443 mg/L. Conventional bacterial cultures were repeatedly negative; however, mNGS of CSF identified Up (115 sequence reads; relative abundance 87.19%). Following targeted treatment with azithromycin, CSF inflammatory markers improved. Nevertheless, given the severity of the intracranial lesions, the family ultimately chose to withdraw care. Conclusion:This case suggests that Up infection may act as a synergistic factor in the development or progression of severe ICH in extremely preterm infants. Potential mechanisms include direct injury to the cerebral vascular endothelium and fragile germinal matrix vessels, as well as blood-brain barrier disruption secondary to inflammatory cytokine release. In extremely preterm infants with unusually rapid progression of ICH and poor response to conventional treatment, Up infection should be considered early, and mNGS testing should be arranged without delay. As this is a single case report, the causal relationship warrants confirmation in future studies.