title: Lipopolysaccharide-binding protein as marker of fetal inflammatory response syndrome after preterm premature rupture of membranes.
abstract: BACKGROUND
  Intra-amniotic inflammation with preterm premature rupture of membranes (PPROM) is a risk factor for fetal inflammatory response syndrome (FIRS) and adverse neonatal outcome.
  
  
  OBJECTIVE
  To evaluate the diagnostic accuracy of lipopolysaccharide-binding protein (LBP) for detecting FIRS in preterm neonates born after PPROM.
  
  
  METHODS
  This was a prospective study in the level III neonatal intensive care unit (42 neonates; 23 + 6 to 31 + 6 weeks' gestation) of mothers with PPROM. Umbilical cord blood concentrations of LBP, C-reactive protein (CRP), interleukin (IL)-6 and white blood cell count with differential were measured at delivery and 24 h after birth. Neonates were classified into FIRS (n = 22) and no FIRS (n = 20) groups according to clinical criteria and IL-6 level (≥17.5 pg/ml). Histological examination of the placenta and umbilical cord was performed. Neurological examination at 12 months' corrected age was performed.
  
  
  RESULTS
  Umbilical cord blood concentration of LBP was significantly higher in the FIRS group than in the no FIRS group at delivery (median 21.6 mg/l vs. median 2.3 mg/l; p < 0.0001) and 24 h after birth (median 17.2 mg/l vs. median 20.0 mg/l; p < 0.001). The area under the ROC curve for FIRS at delivery was 0.98 (95% CI 0.88-1.0) for LBP, 0.92 (95% CI 0.80-0.99) for CRP and 0.82 (95% CI 0.64-0.94) for immature to total neutrophil ratio. Similar results were obtained if FIRS was defined by funisitis. Umbilical cord blood concentration of LBP at delivery was significantly higher in neonates with abnormal neurological exam at 12 months than in those with normal exam (median 19.5 mg/l vs. median 3.75 mg/l; p < 0.015).
  
  
  CONCLUSIONS
  In preterm neonates born to asymptomatic women with PPROM, LBP in cord blood at delivery is an excellent diagnostic biomarker of FIRS/funisitis with prognostic potential.
authors: Department of Paediatric Surgery and Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia.
authors: Maja
authors: M
authors: Pavcnik-Arnol
authors: Miha
authors: M
authors: Lucovnik
authors: Lilijana
authors: L
authors: Kornhauser-Cerar
authors: Tanja
authors: T
authors: Premru-Srsen
authors: Sergej
authors: S
authors: Hojker
authors: Metka
authors: M
authors: Derganc
mesh_terms: D000209:Acute-Phase Proteins; D015415:Biomarkers / Q000097:blood*; D002352:Carrier Proteins / Q000097:blood*; D002821:Chorioamnionitis / Q000097:blood / Q000175:diagnosis / Q000401:mortality; D005260:Female; D005312:Fetal Blood / Q000737:chemistry / Q000378:metabolism; D005322:Premature Rupture of Fetal Membranes / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D006801:Humans; D007226:Infant Mortality; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D008562:Membrane Glycoproteins / Q000097:blood*; D011237:Predictive Value of Tests; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood* / Q000175:diagnosis / Q000401:mortality; D000099231:Lipopolysaccharide-Binding Protein
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; D002352:Carrier Proteins; D008562:Membrane Glycoproteins; D000099231:Lipopolysaccharide-Binding Protein