Maternal chorioamnionitis and umbilical vein interleukin-6 levels for identifying early neonatal sepsis.
OBJECTIVE
The purpose of this study was to determine whether elevated levels of umbilical vein IL-6 would be a better marker for early neonatal sepsis than the clinical signs of maternal chorioamnionitis.


METHODS
Patients delivering preterm because of spontaneous preterm labor or premature rupture of the membranes were evaluated for clinical signs of chorioamnionitis, which was defined as a temperature of > or =100.4 degrees F along with > or =2 of the following: significant maternal tachycardia (> or = 120 bpm), fetal tachycardia (> or =160 bpm), purulent discharge, uterine tenderness, and leukocytosis (WBC > or =18,000 cells/mm3). Umbilical vein blood was assayed for interleukin-6. An elevated interleukin-6 level was determined to be 25 pg/mL. Infants were evaluated for evidence of early neonatal sepsis. The abilities of clinical chorioamnionitis and interleukin-6 levels > or =25 pg/mL to predict early neonatal sepsis were compared.


RESULTS
There were 28 patients delivering 14 (50%) neonates with evidence for early neonatal sepsis. The incidence of suspected neonatal sepsis in women with and without clinical chorioamnionitis was 6/10 (60%) vs. 8/18 (44.4%), P = 0.43. Using receiver operator characteristic curves, the best cutoff for interleukin-6 was found to be 25 pg/mL. The compared sensitivity, specificity, and positive and negative predictive values of clinical chorioamnionitis vs. interleukin-6 levels > or =25 pg/mL for predicting early neonatal sepsis were 42.9% vs. 92.9%, 71.4% vs. 92.9%, 60% vs. 92.9%, and 55.6% vs. 92.9%, respectively.


CONCLUSIONS
Elevated umbilical vein levels of interleukin-6 predict those preterm infants with early sepsis better than the presence of clinical chorioamnionitis.
Smulian
J C
JC
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Medicine and Dentistry of New Jersey - Robert Wood Johnson Medical School/Saint Peter's University Hospital, New Brunswick 08903-0591, USA. smuliajc@umdnj.edu
Vintzileos
A M
AM
Lai
Y L
YL
Santiago
J
J
Shen-Schwarz
S
S
Campbell
W A
WA
D002821:Chorioamnionitis / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D015850:Interleukin-6 / Q000097:blood*; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000175:diagnosis* / Q000209:etiology; D014471:Umbilical Veins
D015850:Interleukin-6