Detection of Interleukin-6 in Maternal Plasma Predicts Neonatal and Infectious Complications in Preterm Premature Rupture of Membranes

ABSTRACT

The objective of this study is to determine if the detection of interleukin-6 (IL-6) in maternal plasma prior to delivery predicts neonatal and/or infectious complications in patients with preterm premature rupture of membranes. Patients with preterm premature rupture of membranes between 24 and 35 weeks' gestation were asked to participate in the study. Maternal blood was obtained prior to delivery. All patients received Ampicillin-sulbactam and steroids. IL-6 concentrations were determined by enzyme-linked immunoadsorbent assay (ELISA) using 50 mL of plasma assayed in duplicate. ELISA sensitivity was 18 pg/mL. Neonatal and infectious complications examined were respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage, intra-amniotic infection, presumed neonatal sepsis, neonatal sepsis, and congenital pneumonia. Fifty-seven patients' plasma was analyzed. Thirty-five had positive plasma IL-6 prior to delivery. Twenty-seven patients had at least one neonatal complication with 24 (89%) being positive for IL-6. Of the 30 patients without complications, only 11 (37%) were positive (p = 0.0001, OR 13.8. 95% CI, 2.93-74.7). A subanalysis of patients who received a course of corticosteroids was performed and significance was maintained. Ten of 13 patients (77%) with neonatal complications had positive IL-6 compared with 40% without complications (p ≤0.01). Infectious morbidity occurred in 32 patients with 24 having positive IL-6 values (75%). Only 11 of 25 (44%) without infections were positive (p ≤0.03, OR 3.82, 95%, CI 1.09-13.0). The presence of IL-6 in the maternal plasma predicted patients with neonatal complications. These correlations persisted when the data were stratified for those patients who received corticosteroids. It also predicted infectious complications.

KEYWORD

Interleukin 6 - preterm premature rupture of membranes - neonatal complications - infectious morbidity

REFERENCES

• 1 Daikoku N H, Kaltreider D F, Khouzani V A, Spence M, Johnson J WC. Premature rupture of membranes and spontaneous preterm labor: maternal endometritis risks.  Obstet Gynecol . 1982;  59 13-19
• 2 Mercer B M, Arheart K L. Antimicrobial therapy in expectant management of preterm premature rupture of the membranes.  Lancet . 1995;  346 1271
• 3 Lewis D F, Major C A, Towers C V, Asrat T, Harding J A, Garite T J. Effects of digital vaginal examinations on latency period in preterm premature rupture of membranes.  Obstet Gynecol . 1992;  80 630-634
• 4 Romero R, Yoon B H, Mazor M. A comparative study of the diagnostic performance of amniotic fluid cultures, white blood cell count, interleukin-6 and gram stain in the detection of microbial invasion in patients with premature rupture of membranes.  Am J Obstet Gynecol . 1991;  65 1099-1104
• 5 Murtha A P, Greig P C, Jimmerson C E, Hebert W N. Maternal serum interleukin-6 concentration as a marker for impending preterm delivery.  Obstet Gynecol . 1998;  91 161-164
• 6 Lencki S G, Maciulla M B, Eglinton G S. Maternal and umbilical cord serum interleukin levels in preterm labor with clinical chorioamnionitis.  Am J Obstet Gynecol . 1994;  170 1345-1351
• 7 Weeks J W, Reynold L, Taylor P, Lewis J, Wan T, Gall S A. Umbilical cord blood interleukin-6 levels and neonatal morbidity.  Obstet Gynecol . 1997;  90 815-818
• 8 Yoon B H, Romero R, Kim C J. Amniotic fluid interleukin-6: a sensitive test for antenatal diagnosis of acute inflammatory lesions of preterm placenta and predictions of perinatal morbidity.  Am J Obstet Gynecol . 1995;  172 960-970
• 9 Yoon B H, Romero R, Yang S H. Interleukin-6 concentrations in umbilical cord plasma are elevated in neonates with white matter lesions associated with periventricular leukomalacia.  Am J Obstet Gynecol . 1996;  174 1433-1440
• 10 Perenyi A, Johann-Liang R, Stavola J J. Assessment of cord blood IL-6 levels as an indicator of neonatal sepsis.  Am J Perinatol . 1999;  16 525-530
• 11 Salafia C M, Sherer D M, Spong C Y. Fetal but not maternal serum cytokine levels correlate with histologic and placental inflammation.  Am J Perinatol . 1997;  14 419-422
• 12 Mercer B M, Crocke L G, Boe N M, Sibdi B. Induction versus expectant management in premature rupture of the membranes with mature amniotic fluid at 32 to 36 weeks: a randomized trial.  Am J Obstet Gynecol . 1993;  169 775-782
• 13 Yoon B H, Romero R, Park J S. Fetal exposure to an intra-amniotic inflammation and the development of cerebral palsy at the age of three years.  Am J Obstet Gynecol . 2000;  182 675-681