title: Umbilical cord serum interleukin-6, C-reactive protein, and myeloperoxidase concentrations at birth and association with neonatal morbidities and long-term neurodevelopmental outcomes.
abstract: OBJECTIVE
  The aim of the study is to determine if umbilical cord serum concentrations of interleukin-6 (IL-6), C-reactive protein (CRP), and myeloperoxidase (MPO), in pregnancies at risk for preterm birth (PTB), are associated with neonatal morbidities and/or altered neurodevelopmental outcomes in the children.
  
  
  METHODS
  Umbilical cord serum samples were collected at birth from 400 newborns delivered within a multicenter randomized controlled trial of repeated versus single course of antenatal corticosteroids (ACs), in women at increased risk for PTB. Newborns were followed through discharge and were evaluated between 36 and 42 months corrected age with neurological examination and Bayley Scales of Infant Development. Umbilical cord serum concentrations of IL-6, CRP, and MPO were determined using enzyme-linked immunoassays. Multivariate logistic regression analyses explored the relationship between umbilical cord serum IL-6, CRP, and MPO levels, adverse newborn outcomes, and PTB < 32 weeks of gestational age (GA).
  
  
  RESULTS
  Univariate analysis revealed that umbilical cord IL-6 above the 75th percentile was associated with increased respiratory distress syndrome (RDS) and chronic lung disease (CLD), but not with necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), or neonatal sepsis; however, this association was not significant after adjusting for GA at delivery and treatment group. No significant associations between CRP or MPO and RDS, CLD, NEC, sepsis, or IVH were evident. Regression analysis revealed that CRP above the 75th percentile was associated with a decreased risk of CLD (odds ratio, 0.10; 95% confidence interval, 0.02-0.41). No associations between umbilical cord IL-6, CRP, or MPO and MDI < 70 or PDI < 70 were evident. Umbilical cord serum concentrations of IL-6, CRP, and MPO, above the 75th percentile, were associated with more frequent PTB < 32 weeks of GA.
  
  
  CONCLUSIONS
  Elevated umbilical cord serum concentration of CRP is associated with reduced risk for CLD even after adjusting for GA at delivery. Occurrence of levels > 75th percentile of IL-6, CRP, and MPO in umbilical cord serum was associated with PTB < 32 weeks of GA. Elevated umbilical cord serum concentrations of IL-6, CRP, and MPO at birth were not associated with poor neurodevelopmental outcomes.
authors: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan.
authors: Yoram
authors: Y
authors: Sorokin
authors: Roberto
authors: R
authors: Romero
authors: Biostatistics Center, The George Washington University, Washington, District of Columbia.
authors: Lisa
authors: L
authors: Mele
authors: Department of Obstetrics and Gynecology, The Ohio State University, Columbus, Ohio.
authors: Jay D
authors: JD
authors: Iams
authors: Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
authors: Alan M
authors: AM
authors: Peaceman
authors: Department of Obstetrics and Gynecology, The University of Texas Southwestern Medical Center, Dallas, Texas.
authors: Kenneth J
authors: KJ
authors: Leveno
authors: Department of Obstetrics and Gynecology, Wake Forest University Health Sciences, Winston-Salem, North Carolina.
authors: Margaret
authors: M
authors: Harper
authors: Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors: Steve N
authors: SN
authors: Caritis
authors: Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors: Brian M
authors: BM
authors: Mercer
authors: Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors: John M
authors: JM
authors: Thorp
authors: Department of Obstetrics and Gynecology, University of Miami, Miami, Florida.
authors: Mary Jo
authors: MJ
authors: O'Sullivan
authors: Department of Obstetrics and Gynecology, The University of Texas Health Science Center at Houston, Houston, Texas.
authors: Susan M
authors: SM
authors: Ramin
authors: Department of Obstetrics and Gynecology, Brown University, Providence, Rhode Island.
authors: Marshall W
authors: MW
authors: Carpenter
authors: Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama.
authors: Dwight J
authors: DJ
authors: Rouse
authors: Department of Obstetrics and Gynecology, University of Tennessee, Memphis, Tennessee.
authors: Baha
authors: B
authors: Sibai
mesh_terms: D002097:C-Reactive Protein / Q000378:metabolism*; D002657:Child Development; D020345:Enterocolitis, Necrotizing / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D005312:Fetal Blood / Q000378:metabolism*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000097:blood; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood*; D015850:Interleukin-6 / Q000097:blood*; D020300:Intracranial Hemorrhages / Q000097:blood; D016015:Logistic Models; D008171:Lung Diseases / Q000097:blood; D015999:Multivariate Analysis; D009195:Peroxidase / Q000097:blood*; D011247:Pregnancy; D047928:Premature Birth / Q000097:blood*; D012127:Respiratory Distress Syndrome, Newborn / Q000097:blood; D018805:Sepsis / Q000097:blood
chemical_list: C508600:IL6 protein, human; D015850:Interleukin-6; D002097:C-Reactive Protein; D009195:Peroxidase