title: The fetal inflammatory response syndrome is a risk factor for morbidity in preterm neonates.
abstract: OBJECTIVE
  The aim of this study was to show and discuss an association between fetal inflammatory response syndrome (FIRS) and an adverse neonatal outcome defined as combined severe neonatal morbidity and mortality in preterm neonates hospitalized in our neonatal intensive care unit.
  
  
  METHODS
  This was an observational study including all preterm neonates hospitalized in our neonatal intensive care unit over a 21 month period. FIRS was defined as cord blood interleukin (IL)-6 greater than 11 pg/mL. Main outcome parameter was an adverse neonatal outcome defined as hospital mortality and/or the presence of any of 5 prespecified morbidities (bronchopulmonary dysplasia, periventricular leukomalacia, intraventricular hemorrhage, and early- or late-onset sepsis).
  
  
  RESULTS
  Fifty-seven of 176 preterm infants hospitalized during the study period (32%) had an adverse neonatal outcome and 62 of these 176 infants (35%) had FIRS with median IL-6 values of 51.8 pg/mL (range, 11.2 to >1000 pg/mL). In a regression analysis, FIRS was significantly associated with adverse neonatal outcome (P < .001) and with the single outcome parameters, intraventricular hemorrhage and early-onset sepsis (P = .006 and P = .018, respectively). In the bivariate analysis, FIRS was associated with death and bronchopulmonary dysplasia (P = .004 and P < .001, respectively). IL-6 correlated with adverse neonatal outcome (r = 0.411, P < .001). When comparing the correlation in neonates less than 32 weeks' gestational age (r = 0.481, P < .001) with neonates 32 weeks or longer (r = 0.233, P = .019), the difference was nearly significant (P = .065).
  
  
  CONCLUSIONS
  FIRS is a risk factor for adverse neonatal outcome in preterm infants. In particular, the combination of IL-6 greater than 11 pg/mL and low gestational age increased the risk for severe neonatal morbidity or death.
authors.affiliation: Research Unit for Neonatal Infectious Diseases and Epidemiology, Medical University of Graz, Graz, Austria.
authors.forename: Nora
authors.initials: N
authors.lastname: Hofer
authors.forename: Radhika
authors.initials: R
authors.lastname: Kothari
authors.forename: Nicholas
authors.initials: N
authors.lastname: Morris
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Müller
authors.forename: Bernhard
authors.initials: B
authors.lastname: Resch
mesh_terms: D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005312:Fetal Blood / Q000276:immunology; D005315:Fetal Diseases; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D007235:Infant, Premature, Diseases / Q000401:mortality*; D007363:Intensive Care Units, Neonatal; D015850:Interleukin-6 / Q000097:blood*; D008297:Male; D016017:Odds Ratio; D012372:ROC Curve; D012044:Regression Analysis; D012307:Risk Factors; D018746:Systemic Inflammatory Response Syndrome / Q000401:mortality / Q000503:physiopathology*
chemical_list: D015850:Interleukin-6
keywords: bronchopulmonary dysplasia; fetal inflammatory response syndrome; intraventricular hemorrhage; neonatal sepsis; periventricular leukomalacia