title: Neutrophil defensins but not interleukin-6 in vaginal fluid after preterm premature rupture of membranes predict fetal/neonatal inflammation and infant neurological impairment.
abstract: 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.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Tertiary referral university hospital.
  
  
  METHODS
  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.
  
  
  METHODS
  Fetal inflammatory response syndrome was defined as neonatal inflammation within 72 hours 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.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Perinatology, University Medical Center Ljubljana, Slovenia. mihalucovnik@yahoo.com
authors.forename: Miha
authors.initials: M
authors.lastname: Lucovnik
authors.forename: Lilijana
authors.initials: L
authors.lastname: Kornhauser-Cerar
authors.forename: Tanja
authors.initials: T
authors.lastname: Premru-Srsen
authors.forename: Tanja
authors.initials: T
authors.lastname: Gmeiner-Stopar
authors.forename: Metka
authors.initials: M
authors.lastname: Derganc
mesh_terms: D000653:Amniotic Fluid / Q000378:metabolism*; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000378:metabolism*; D006801:Humans; D007231:Infant, Newborn; D007249:Inflammation / Q000175:diagnosis* / Q000378:metabolism; D015850:Interleukin-6 / Q000378:metabolism*; D009422:Nervous System Diseases / Q000175:diagnosis* / Q000378:metabolism; D007752:Obstetric Labor, Premature / Q000378:metabolism; D011247:Pregnancy; D023084:alpha-Defensins / Q000378:metabolism*
chemical_list: D015850:Interleukin-6; D023084:alpha-Defensins