Open AccessNeutrophil defensins but not interleukin‐6 in vaginal fluid after preterm premature rupture of membranes predict fetal/neonatal inflammation and infant neurological impairment
Author(s) -
LUCOVNIK MIHA,
KORNHAUSERCERAR LILIJANA,
PREMRUSRSEN TANJA,
GMEINERSTOPAR TANJA,
DERGANC METKA
Publication year - 2011
Publication title -
acta obstetricia et gynecologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.401
H-Index - 102
eISSN - 1600-0412
pISSN - 0001-6349
DOI - 10.1111/j.1600-0412.2011.01177.x
Subject(s) - medicine , inflammation , premature rupture of membranes , fetus , obstetrics , interleukin , chorioamnionitis , pregnancy , immunology , cytokine , biology , genetics
Objective. To determine whether neutrophil defensins (HNP1–3) and interleukin‐6 (IL‐6) in vaginal fluid after preterm premature rupture of membranes predict fetal inflammatory response syndrome (FIRS), neurological impairment or chorioamnionitis. Design. Prospective study. Setting. Tertiary referral university hospital. Population. Forty‐two patients with preterm premature rupture of membranes at <32 weeks. Methods. Levels of HNP1–3 and IL‐6 were measured in vaginal fluid obtained by swabs. Mann–Whitney U ‐test was used to compare HNP1–3 and IL‐6 levels in groups with vs. without FIRS, infant death or neurological impairment, and chorioamnionitis ( p <0.05 significant). Logistic regression was used to control for potential confounders. Diagnostic accuracies of HNP1–3 and IL‐6 were determined by receiver operator characteristics analysis. Main Outcome Measures. Fetal inflammatory response syndrome was defined as neonatal inflammation within 72hours postpartum. Neurological impairment was defined as motor and/or tone abnormalities at one year of corrected age. Chorioamnionitis was diagnosed histologically. Results. Levels of HNP1–3, but not IL‐6, were higher in 12 cases of FIRS ( p =0.019 and p =0.256, respectively). Levels of HNP1–3, but not IL‐6, were higher in 14 cases of infant death or neurological impairment ( p =0.015 and p =0.100, respectively) and, when only survivors were analyzed, in nine cases of neurological impairment ( p =0.030 and p =0.187, respectively). Levels of HNP1–3 and IL‐6 were higher in 29 cases of chorioamnionitis ( p =0.005 and p =0.003, respectively). The differences remained significant after adjustment for gestational age. Levels of HNP1–3 predicted FIRS, infant death or neurological impairment and chorioamnionitis with an area under the curve of 0.75, 0.79 and 0.78, respectively. Conclusions. Elevated vaginal fluid HNP1–3 and IL‐6 levels are associated with histological chorioamnionitis. Elevated HNP1–3 can also identify FIRS and predict infant death or neurological impairment.