Abstract
Objective: The purpose of this study was to test the hypothesis that a systemic fetal inflammatory
response is a risk factor for the subsequent development of bronchopulmonary dysplasia
in preterm neonates. Study Design: The relationship between interleukin 6 concentrations in umbilical cord plasma at
birth and the occurrence of bronchopulmonary dysplasia was examined in 203 preterm
births (25-34 weeks). Ninety-six patients underwent transabdominal amniocentesis within
5 days of birth. The relationship between umbilical cord plasma interleukin 6 concentration
and bronchopulmonary dysplasia was compared with the relationship between amniotic
fluid interleukin 6 concentration and bronchopulmonary dysplasia. Interleukin 6 was
measured by specific immunoassay. Logistic regression was used for statistical analysis.
Results: Bronchopulmonary dysplasia was diagnosed in 17% (34/203) of the infants. Neonates
in whom bronchopulmonary dysplasia developed had a significantly higher median interleukin
6 concentration in umbilical cord plasma at birth than did those in whom bronchopulmonary
dysplasia did not develop (median, 68.3 pg/mL and range, 0.3-6150.0 pg/mL vs median,
6.9 pg/mL and range 0-19,230.0 pg/mL; P < .001). This difference remained significant after adjustment for gestational age
at birth (odds ratio, 4.2; 95% confidence interval, 1.6-11.2). Logistic regression
analysis indicated that an elevated umbilical cord plasma interleukin 6 concentration
was a better predictor of the development of bronchopulmonary dysplasia than was an
elevated amniotic fluid interleukin 6 concentration (P < .005). Conclusion: An elevated interleukin 6 concentration in umbilical cord plasma at birth is an independent
risk factor for the development of bronchopulmonary dysplasia. These data support
the concept that the injury responsible for bronchopulmonary dysplasia in a subset
of neonates may begin before birth and is associated with the development of a fetal
systemic inflammatory response, as determined by plasma concentrations of interleukin
6. (Am J Obstet Gynecol 1999;181:773-9.)
Keywords
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Article Info
Footnotes
☆Supported by grant HMP-98-M-4-0047 of the 1998 Good Health R&D Project, Ministry of Health and Welfare, Republic of Korea, and grant 03-98-010 from the Seoul National University Hospital Research Fund.
☆☆Dr Romero participated as a private citizen, not as an agent of the US government or of any of the universities to which he holds appointments.
★Reprint requests: Bo Hyun Yoon, MD, PhD, Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, 110-744, Korea.
★★0002-9378/99 $8.00 + 06/6/100576
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© 1999 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
