Ingrida Pilypienė, Nijolė Drazdienė, Irena Dumalakienė, Nijolė Vezbergienė, Daiva Bartkevičienė, Mindaugas Šilkūnas
Abstract
Intrauterine infection may induce fetal infection and inflammation as well as initiate the fetal inflammatory response that is defined as fetal inflammatory response syndrome (FIRS). FIRS could be the cause of heavy fetal injuries and create health disorders for the preterms such as cerebral paralysis and chronic lung disease.
Microoorganisms and their isolated substances induce fetal mononuclear cells to produce inflammatory markers, i.e. cytokines and chemokines possessing the ability to increase the permeability of hematoencephalic barrier, to induce the injury of oligodendrocytes and destroy the production of myelin. Newborns with the diagnosed PVL were found to have the increased amounts of TNF-α, IL-6, IL-1β and IL-2 in their white matter. Because of the damage of the brain white matter the following disorders in the development of the child could occur: limited environmental cognition, behavioural disorders, distorted image perception or cerebral paralysis. The detection of inflammatory markers in fetal blood could help to elucidate the causes of these disorders.
The aim of this study was to investigate and assess the effect of FIRS for the psychomotor evolution of 6 and 12 months preterms and to define the risk of retardation in their development.
Methods of investigation. 144 preterm infants, born at 24-34 weeks of gestation, were subjected for investigation at Vilnius City University Hospital and Vilnius University Children hospital in the period of 2007-2009. Immunological studies of umbilical cord blood samples were performed at the Institute of Immunology of Vilnius University. The levels of IL-6 in umbilical cord blood were determined by ELISA. Psychomotor development of 6 and 12 month corrected age babies was evaluated at Vilnius University Children hospital by the Munich functional development technique.
Results.Psychomotor development of 6 month corrected age preterm infants was retarded as compared with the control group (p<0.05) in cases when IL-6 amount in umbilical cord blood was found to be >11.0 pg/ml (FIRS group), however the average age of the group did not express significant differences in the development (p=0.093). The development of motor and cognitive functions in 12 month corrected age FIRS group infants was significantly retarded in comparison with the control group (p<0.01) and average difference between the median of the age groups was found to be significant as well (p<0.01). Taking into the account the age of gestation at which the preterms were born, the relative risk could be predicted in prognosticating the retardation in general psychomotor development for the 12 month corrected age babies for ≥2 month (RR 2.7; 95 % PI 1.6-4.7; p<0.001), movement retardation for ≥2 month (RR 3.8; 95 % PI 2.0-7.2; p<0.001) and psychosocial development for ≥2 month (RR 2.8; 95 % PI 1.5-5.0; p<0.01).
Conclusions. 1. The age of psychomotor development of FIRS affected preterms born at the 24-34 week of gestation becomes significantly smaller in comparison with other preterms at the corrected age of 12 months. However, the psychomotor development of FIRS affected infants at 6 month of corrected age did not differ from other preterm infants; 2. Newborns affected with FIRS, i.e., when IL-6 amount in umbilical cord blood was found to be ≥11.0 pg/ml at the corrected age of 12 month express higher risk for the retardation of psychomotor development; 3. For the preterm newborns when predicting 12 months corrected age prognosis it is advisable to identify the amount of IL-6 in the umbilical cord blood.
Keyword(s): preterm delivery, intrauterine infection, cytokines, fetal inflammatory response, periventricular leukomalacia
DOI: 10.5200/12
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