Umbilical vein interleukin 6 and tumor necrosis factor alpha plasma concentrations in the very preterm infant

Objective. To examine the relationship between umbilical vein plasma concentrations of interleukin 6 (IL-6) and tumor necrosis factor (TNF)-alpha and early neonatal sepsis in the very preterm infant, and the histopathologic findings of chorioamnionitis in the placentas from these pregnancies. Methods. A prospective study was conducted in 43 very preterm, singleton infants delivered at or before 32 weeks of gestation. IL-6 and TNF-alpha were measured by enzyme-linked immunoassay. Placentas from these pregnancies were histologically examined for the presence of chorioamnionitis. Infants were prospectively classified as confirmed sepsis group, clinical sepsis group or control group. IL-6 and TNF-alpha plasma concentrations were not normally distributed, so they were transformed to their natural log values for statistical analysis. Results. The enrolled infants had a mean gestational age of 27.2 ± 2.7 weeks and a mean birth weight of 956 ± 325 g. Three (7%) infants had confirmed sepsis, 18 (42%) were in the clinical sepsis group and 22 (51%) were in the control group. IL-6 concentrations but not TNF-alpha were significantly higher (P < 0.05) in the confirmed (8.9 ± 1.7) and clinical sepsis (5.5 ± 2.4) groups in comparison with the control group (2.1 ± 1.6). We examined 42 placentas. Twenty-three (55%) had no evidence of chorioamnionitis, 1 (2%) had mild grade, 8 (19%) had a moderate grade and 10 (24%) had a severe grade of chorioamnionitis. IL-6 was significantly elevated in the moderate (5.9 ± 1.6 vs. 1.9 ± 1.6) and severe grade (7.2 ± 2.3 vs. 1.9 ± 1.6) of chorioamnionitis, in the presence of acute deciduitis (6.0 ± 2.7 vs. 2.1 ± 1.8), chorionic vasculitis (6.8 ± 2.1 vs. 2.2 ± 1.9) and funisitis (7.3 ± 1.9 vs. 2.7 ± 2.3) (P < 0.05) TNF-alpha plasma concentrations were not significantly different. Conclusion. An elevated umbilical vein IL-6 concentration is a good indicator of sepsis syndrome in the very preterm infant and also correlates with histologic chorioamnionitis in these pregnancies.