title: Limiting the Exposure of Select Fetuses to Intrauterine Infection/Inflammation Improves Short-Term Neonatal Outcomes in Preterm Premature Rupture of Membranes.
abstract: BACKGROUND
  To improve neonatal outcomes in pregnancies at heightened risk for early-onset neonatal sepsis (EONS), there is a need to identify fetuses that benefit from expectant management as opposed to early delivery. Detectable haptoglobin and haptoglobin-related protein (Hp&amp;HpRP switch-on status) in cord blood has been proposed as a biomarker of antenatal exposure to intra-amniotic infection and/or inflammation (IAI), an important determinant of EONS.
  
  
  METHODS
  We analyzed 185 singleton newborns delivered secondary to preterm premature rupture of membranes (PPROM). In 123 cases, amniocentesis was performed to exclude amniotic fluid (AF) infection. Delivery was indicated for 61 cases with confirmed infection. Women without AF infection (n = 62) and those without amniocentesis (n = 62) were managed expectantly. Interleukin 6 and Hp&amp;HpRP switch-on status were evaluated by ELISA and Western blot. Newborns were followed prospectively for short-term outcomes until hospital discharge or death.
  
  
  RESULTS
  Newborns exposed antenatally to IAI had an increased risk of adverse neonatal outcome [OR: 3.0 (95% CI: 1.15-7.59)]. Increasing gestational age [OR: 0.61 (95% CI: 0.52-0.70)] and management with amniocentesis [OR: 0.37 (95% CI: 0.14-0.95)] lowered the newborn's risk of developing adverse outcomes.
  
  
  CONCLUSIONS
  In the setting of PPROM and IAI, early delivery benefits a select subgroup of fetuses that have not yet progressed to Hp&amp;HpRP switch-on status.
authors: Departments of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, Conn., USA.
authors: Karen L
authors: KL
authors: Archabald
authors: Irina A
authors: IA
authors: Buhimschi
authors: Mert O
authors: MO
authors: Bahtiyar
authors: Antonette T
authors: AT
authors: Dulay
authors: Sonya S
authors: SS
authors: Abdel-Razeq
authors: Christian M
authors: CM
authors: Pettker
authors: Heather S
authors: HS
authors: Lipkind
authors: John T
authors: JT
authors: Hardy
authors: Megan E
authors: ME
authors: McCarthy
authors: Guomao
authors: G
authors: Zhao
authors: Vineet
authors: V
authors: Bhandari
authors: Catalin S
authors: CS
authors: Buhimschi
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000378:metabolism / Q000382:microbiology*; D000951:Antigens, Neoplasm / Q000378:metabolism; D036861:Delivery, Obstetric; D005260:Female; D005312:Fetal Blood / Q000378:metabolism; D005322:Premature Rupture of Fetal Membranes / Q000378:metabolism / Q000382:microbiology / Q000628:therapy; D005865:Gestational Age; D006242:Haptoglobins / Q000378:metabolism; D006801:Humans; D007231:Infant, Newborn; D007239:Infections / Q000209:etiology* / Q000378:metabolism / Q000382:microbiology; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000951:Antigens, Neoplasm; C058632:HPR protein, human; D006242:Haptoglobins
keywords: Intrauterine infection/inflammation; Preterm premature rupture of membranes; Select fetuses; Short-term neonatal outcomes