Impaired whole-blood polymorphonuclear leukocyte migration as a possible predictive marker for infections in preterm premature rupture of membranes.
OBJECTIVE
Steroids, used in preterm premature rupture of membranes (pPROM), to reduce the risk of morbidity and mortality of the preterm neonate, impair the maternal polymorphonuclear leukocyte (PMN)-based immune system. In spite of combination with antibiotics, prenatal and postnatal bacterial infections of mother and child are frequent. This pilot study focuses on the influence of steroids in pPROM on maternal PMN functional capacity and subsequent infections.


METHODS
After opting for expectant management, eight women with pPROM and no signs of infection were treated by steroids (betamethasone 5.7 mg, i.m. every 24 hours, for three days) and antibiotic therapy with either amoxicillin and clavulanic acid, piperacillin or ampicillin i.v. up to delivery. The conventional inflammation parameters of PMN blood count and C-reactive protein (CRP) were measured daily in parallel with PMN migratory capacity towards N-formyl-methionyl-leucyl-phenylalanine stimulation and under blank conditions, estimated by a whole blood membrane filter assay.


RESULTS
In all patients PMN migration decreased during the application of steroids. Three patients showed a decrease in PMN migration below critical values and in spite of antibiotic prophylaxis acute pyelonephritis developed 2-6 days later. PMN count and CRP were not predictive of maternal infection.


CONCLUSIONS
Reduced PMN function, caused by steroid treatment in pPROM, is suggested to be a reason for serious bacterial infections in spite of antibiotic prophylaxis. PMN migration reflects individual PMN defensive capacity.
Glasner
A
A
Department of Obstetrics and Gynecology, All Karl Franzens University, Graz, Austria. dr.a.glasner@chello.at
Egger
G
G
Winter
R
R
D019072:Antibiotic Prophylaxis; D001623:Betamethasone / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001772:Blood Cell Count; D002097:C-Reactive Protein / Q000378:metabolism; D002465:Cell Movement / Q000187:drug effects / Q000276:immunology; D002633:Chemotaxis / Q000187:drug effects; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000097:blood / Q000188:drug therapy / Q000382:microbiology*; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D009504:Neutrophils / Q000187:drug effects / Q000276:immunology*; D010865:Pilot Projects; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000097:blood / Q000382:microbiology*; D011704:Pyelonephritis / Q000652:urine; D012189:Retrospective Studies
D015415:Biomarkers; D005938:Glucocorticoids; D002097:C-Reactive Protein; D001623:Betamethasone