Original Paper

Intrauterine Inflammation and the Onset of Peri-Intraventricular Hemorrhage in Premature Infants
Janez Babnik^a, Irena tucin-Gantar^a, Lilijana Kornhauser-Cerar^a, Jasna inkovec^a, Branka Wraber^b, Metka Derganc<sup>c

a</sup>Division of Perinatology, Department of Obstetrics and Gynecology, University Medical Center Ljubljana,
^bInstitute of Microbiology, Medical Faculty, University of Ljubljana, and
^cDepartment of Pediatric Surgery and Intensive Care, University Medical Center Ljubljana, Ljubljana, Slovenia

Address of Corresponding Author

Biol Neonate 2006;90:113-121 (DOI: 10.1159/000092070)

  Key Words

• Fetal inflammation
• Interleukin-6
• Interleukin-8
• Chorioamnionitis
• Intraventricular hemorrhage

  Abstract

Background: Peri-intraventricular hemorrhage (P/IVH) is a common neonatal morbidity among premature infants. The aim of the study was to examine the association between placental and/or fetal inflammation and the onset of P/IVH in premature infants. Methods: A prospective study included 125 infants with gestational age 23-29 weeks. Placentas were examined for the presence of chorioamnionitis and funisitis, cord blood was sampled for the measurement of cytokines (IL-6 and IL-8). Fetal inflammation was defined as levels of IL-6 higher than 7.6 pg/ml. P/IVH was defined as early if diagnosed within the 1st day after birth; thereafter P/IVH was defined as late. Results: Adjusted for the influence of gestational age, early-onset sepsis (OR 3.2, p = 0.045) and no or incomplete antenatal steroid course (OR 6.0, p = 0.001) significantly predicted early P/IVH. Funisitis (OR 1.6, p = 0.06) and fetal inflammation (OR 2.6, p = 0.06) were only partially associated with early hemorrhage. Contrary to that, respiratory distress syndrome (OR 3.4, p = 0.04), mechanical ventilation (OR 5.9, p = 0.008), low blood pressure (OR 3.5, p = 0.02), and vasopressors (OR 5.7, p = 0.002) were associated with late P/IVH. In multivariate analysis no or incomplete steroid course remained independent predictors for early and use of vasopressors for late P/IVH. The interaction of fetal inflammation and vaginal delivery with no or incomplete steroid course increased the risk of early P/IVH. Conclusions: These results indicate different risk factors for early and late P/IVH. Neither funisitis nor fetal inflammation independently predicts the onset of P/IVH. However, the interaction of fetal inflammation and vaginal delivery with no or incomplete antenatal steroid course increase the risk of early but not also late P/IVH.

Copyright © 2006 S. Karger AG, Basel

  Author Contacts

Janez Babnik, MD, MSc
Division of Perinatology, Department of Obstetrics and Gynecology
University Medical Center, Zaloska 11
SI-1000 Ljubljana (Slovenia)
Tel. +386 1 524 31 50, Fax +386 1 522 61 30, E-Mail janez.babnik@guest.arnes.si

  Article Information

Received: May 2, 2005
Accepted after revision: October 20, 2005
Published online: March 17, 2006
Number of Print Pages : 9
Number of Figures : 2, Number of Tables : 5, Number of References : 43