Presented at the Neonatal Society 2003 Autumn Meeting.
Harling AE1, Yoxall CW1, Vince GS2, Bates M2
1 Liverpool Women’s Hospital, Crown St, Liverpool L8 7SS, UK
2 Immunology Dept. University of Liverpool, Liverpool L69 3GA, UK
Background: Several published works have suggested that the inflammatory process that leads to BPD may begin in the antenatal period, but the evidence is conflicting.
Objective: Our objective was to investigate whether the markers of systemic inflammation (cord blood cytokines and placental histology) and fetal pulmonary inflammation (bronchoalveolar lavage fluid cytokines and inflammatory cell counts at birth) were related to later respiratory outcome.
Method: Ninety-eight babies of less than 33 weeks gestation were observed. Bronchoalveolar lavage fluid (BAL) was obtained from 62 babies immediately after birth and umbilical cord blood serum (CBS) was obtained from 40 babies, from which the concentrations of interleukins (IL) 6, IL-10, IL-1β and Tumor Necrosis Factor a were measured. BAL fluid inflammatory cell counts were obtained from 45 babies, and histopathological examination of the placenta from 43 babies.
Results: Babies were retrospectively placed into Group 1 – No BPD (n=61) or Group 2 -BPD (oxygen requirement beyond 36 weeks postmenstrual age) or Respiratory Death (n=37). Univariate analysis of the inflammatory markers from BAL fluid, CBS and placental histology did not show any difference between the two groups. Multivariate analysis demonstrated that birthweight (p=0.001), gestation (p=0.000) and cord blood serums IL-6 (p=0.03) were all independently predictive of BPD or respiratory death.
Table 1. Bronchoalveolar Lavage Fluid Cytokines (pg/mL) and CD + cell concentrations (per mL/BAL) in the No BPD group and the BPD/Respiratory Death group. Expressed as Median (range)
Table 2. Cord blood serum cytokine concentrations (per mL of serum) and Placental Histology in the No BPD group and the BPD/Respiratory Death group. Median (range) Number (%)
Conclusion: There was some evidence from cord blood serum IL-6 that the inflammatory process that leads to BPD may start in the antenatal period in some babies. This finding supports other research.
References
1. Van Marter LJ, Dammann O, Allred EN, Leviton A, Pagano M, Moore M, Martin C. J Pediatr 2002; 140:171-176
2. Yoon BH, Romero R, Jun JK, Park KH, Park JD, Ghezzi F, Kim BI. Am J Obstet Gynecol 1977; 177: 825-830
3. Yoon BH, Romero R, Kim KS, Park JS, Ki SH, Kim BI, Jun JK. Am J Obstet Gynecol 1999; 181: 773-779