Abstract
Background: Increased levels of umbilical cord proinflammatory cytokines are associated with early and late neonatal morbidity. Extremely preterm male infants need more circulatory and ventilatory support than female infants, and have worse outcome. Experimental interventions which include administration of interleukin-1 receptor antagonist (IL1-ra) improves cerebral outcome after neonatal brain injury, and stabilise arterial blood pressure after experimental sepsis. Furthermore, IL-1ra is increased in amniotic fluid and neonatal urine from female fetuses/newborns. We tested the hypothesis that umbilical cord IL-1ra is related to infant gender, postnatal blood pressure and neonatal morbidity.
Method: Blood from the umbilical cord of 58 infants (33 male, 25 female) with gestational age <32 weeks was sampled at birth. Receiver operating characteristics (ROC-curve) were used for identifying IL-1ra values with high sensitivity and specificity for “poor outcome”. “Poor outcome” was defined as either death (n=3), grade 3–4 IVH or cystic PVL (n= 9). A cut-off for IL-1ra at 13500 pg/ml rendered an area under the curve (AUC) = 0.735, p-value= 0.013, with 67% sensitivity and 85% specificity for “poor outcome”.
Results: There was no correlation between IL-1ra and newborn gender, blood pressure during the first 72 hours or need for inotrope support. There were significant correlations (p-value; rs) between IL-1ra and a) depression at birth, including Apgar at 1 minute (0.020; −0.305) and 10 minutes (0.020; − 0.313) and, b) age at intubation during the first 12 hours (0.011; −0.330). Besides the association with “poor outcome”, IL-1ra values above 13500 pg/ml were associated with other parameters of neonatal morbidity such as development of NEC (p= 0.015), sepsis with positive blood culture (p= 0.027), and need for extra oxygen at 36 weeks (p= 0.033). There were no significant correlations between IL1-ra >13500 pg/ml and development of ROP (p= 0.096), days with mechanical ventilation (p= 0.098), or clinical seizures (p= 0.220).
Conclusion: IL-1ra levels above 13500 pg/ml in umbilical cord blood are associated with depression at birth, need for early intubation and severe neonatal morbidity.
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Elsmén, E., Ley, D., Cilio, C. et al. 79 High Umbilical Cord Levels of Interleukin-1 Receptor Antagonist are Associated with Severe Neonatal Morbidity. Pediatr Res 56, 477 (2004). https://doi.org/10.1203/00006450-200409000-00102
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DOI: https://doi.org/10.1203/00006450-200409000-00102