Intrauterine inflammation and the onset of peri-intraventricular hemorrhage in premature infants.
BACKGROUND
Peri-intraventricular hemorrhage (P/IVH) is a common neonatal morbidity among premature infants. The aim of the study was to examine the association between placental and/or fetal inflammation and the onset of P/IVH in premature infants.


METHODS
A prospective study included 125 infants with gestational age 23-29 weeks. Placentas were examined for the presence of chorioamnionitis and funisitis, cord blood was sampled for the measurement of cytokines (IL-6 and IL-8). Fetal inflammation was defined as levels of IL-6 higher than 7.6 pg/ml. P/IVH was defined as early if diagnosed within the 1st day after birth; thereafter P/IVH was defined as late.


RESULTS
Adjusted for the influence of gestational age, early-onset sepsis (OR 3.2, p = 0.045) and no or incomplete antenatal steroid course (OR 6.0, p = 0.001) significantly predicted early P/IVH. Funisitis (OR 1.6, p = 0.06) and fetal inflammation (OR 2.6, p = 0.06) were only partially associated with early hemorrhage. Contrary to that, respiratory distress syndrome (OR 3.4, p = 0.04), mechanical ventilation (OR 5.9, p = 0.008), low blood pressure (OR 3.5, p = 0.02), and vasopressors (OR 5.7, p = 0.002) were associated with late P/IVH. In multivariate analysis no or incomplete steroid course remained independent predictors for early and use of vasopressors for late P/IVH. The interaction of fetal inflammation and vaginal delivery with no or incomplete steroid course increased the risk of early P/IVH.


CONCLUSIONS
These results indicate different risk factors for early and late P/IVH. Neither funisitis nor fetal inflammation independently predicts the onset of P/IVH. However, the interaction of fetal inflammation and vaginal delivery with no or incomplete antenatal steroid course increase the risk of early but not also late P/IVH.
Division of Perinatology, Department of Obstetrics and Gynecology, University Medical Center Ljubljana, Ljubljana, Slovenia. janez.babnik@guest.arnes.si
Janez
J
Babnik
Irena
I
Stucin-Gantar
Lilijana
L
Kornhauser-Cerar
Jasna
J
Sinkovec
Branka
B
Wraber
Metka
M
Derganc
D002543:Cerebral Hemorrhage / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology*; D002821:Chorioamnionitis / Q000503:physiopathology*; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000209:etiology; D007234:Infant, Premature / Q000502:physiology*; D007249:Inflammation; D015850:Interleukin-6 / Q000032:analysis; D016209:Interleukin-8 / Q000032:analysis; D008297:Male; D015999:Multivariate Analysis; D011247:Pregnancy; D011446:Prospective Studies; D012307:Risk Factors
D015850:Interleukin-6; D016209:Interleukin-8