Umbilical vein interleukin 6 and tumor necrosis factor alpha plasma concentrations in the very preterm infant.
OBJECTIVE
To examine the relationship between umbilical vein plasma concentrations of interleukin 6 (IL-6) and tumor necrosis factor (TNF)-alpha and early neonatal sepsis in the very preterm infant, and the histopathologic findings of chorioamnionitis in the placentas from these pregnancies.


METHODS
A prospective study was conducted in 43 very preterm, singleton infants delivered at or before 32 weeks of gestation. IL-6 and TNF-alpha were measured by enzyme-linked immunoassay. Placentas from these pregnancies were histologically examined for the presence of chorioamnionitis. Infants were prospectively classified as confirmed sepsis group, clinical sepsis group or control group. IL-6 and TNF-alpha plasma concentrations were not normally distributed, so they were transformed to their natural log values for statistical analysis.


RESULTS
The enrolled infants had a mean gestational age of 27.2 +/- 2.7 weeks and a mean birth weight of 956 +/- 325 g. Three (7%) infants had confirmed sepsis, 18 (42%) were in the clinical sepsis group and 22 (51%) were in the control group. IL-6 concentrations but not TNF-alpha were significantly higher (P < 0.05) in the confirmed (8.9 +/- 1.7) and clinical sepsis (5.5 +/- 2.4) groups in comparison with the control group (2.1 +/- 1.6). We examined 42 placentas. Twenty-three (55%) had no evidence of chorioamnionitis, 1 (2%) had mild grade, 8 (19%) had a moderate grade and 10 (24%) had a severe grade of chorioamnionitis. IL-6 was significantly elevated in the moderate (5.9 +/- 1.6 vs. 1.9 +/- 1.6) and severe grade (7.2 +/- 2.3 vs. 1.9 +/- 1.6) of chorioamnionitis, in the presence of acute deciduitis (6.0 +/- 2.7 vs. 2.1 +/-1.8), chorionic vasculitis (6.8 +/- 2.1 vs. 2.2 +/- 1.9) and funisitis (7.3 +/- 1.9 vs. 2.7 +/- 2.3) (P < 0.05) TNF-alpha plasma concentrations were not significantly different.


CONCLUSIONS
An elevated umbilical vein IL-6 concentration is a good indicator of sepsis syndrome in the very preterm infant and also correlates with histologic chorioamnionitis in these pregnancies.
Kashlan
F
F
Department of Pediatrics, University of Medicine and Dentistry of New Jersey, UMDNJ-Robert Wood Johnson Medical School, St. Peter's University Hospital, New Brunswick, NJ 08903, USA. kashlafa@umdnj.edu
Smulian
J
J
Shen-Schwarz
S
S
Anwar
M
M
Hiatt
M
M
Hegyi
T
T
D001772:Blood Cell Count; D002821:Chorioamnionitis / Q000175:diagnosis; D005260:Female; D005312:Fetal Blood / Q000276:immunology*; D005865:Gestational Age; D006801:Humans; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000145:classification / Q000175:diagnosis*; D015850:Interleukin-6 / Q000097:blood*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011446:Prospective Studies; D012372:ROC Curve; D012307:Risk Factors; D018805:Sepsis / Q000145:classification / Q000175:diagnosis*; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000032:analysis*; D014471:Umbilical Veins
D015850:Interleukin-6; D014409:Tumor Necrosis Factor-alpha