Predictability of neonatal infection in cases of preterm premature rupture of membranes by interleukin-6 estimation: antenatal bed side test from vaginal fluid versus neonatal serum testing at birth and after 24 hours

ABSTRACT

The Objective of this study was to assess the predictability of interleukin 6[IL-6] for neonatal infection, in women with preterm premature rupture of membranes [PPROM] using a bed side test from vaginal fluid versus neonatal serum testing at birth and after 24 hours. The study was a cross sectional one and enrolled 73 women who were hospitalized for PPROM. The gestational age at study entry ranged between 28 and 35 completed weeks of gestation that was confirmed from history and/or by a first-trimester ultrasonograhy. Maternal routine investigations as serum C reactive protein [CRP] and IL-6 detection in vaginal fluid were done. Neonatal examination and assessment was done. Initial neonatal outcomes as Apgar score, neonatal infections and neonatal cranial ultrasound were assessed. Neonatal CRP and IL-6 were also estimated. The results showed that neonatal infections were more frequent for babies of women with IL-6-positive vaginal samples [29.7% vs 8.3%; P=0.02]. The sensitivity of vaginal testing of IL-6 for predicting neonatal infection was 79%; its specificity was 56%; its positive predictive value was 30%, and its negative predictive value was 92%. The mean neonatal IL-6 at 0 hour was significantly higher in babies of the vaginally positive than the vaginally negative mothers [P<0.01]. The sensitivity of IL-6 at 0 hour for predicting neonatal infection was 99%; specificity was 91.4%; positive predictive value was 57.4%, and negative predictive value was 92%. The sensitivity at 24 hours was 67.4%; specificity was 69.3%; positive predictive value was 50%, and negative predictive value was 63%. Estimation and detection of IL-6 with both the qualitative vaginal secretions bedside test and at birth neonatal serum are of great value in the prediction of neonatal infection in cases of PPROM. This cytokine may reflect the insult that the fetus had been exposed to hence affection of the fetal brain. Antenatal detection and early at birth estimation are of medico legal importance, which may protect obstetricians and pediatricians from alleged intrapartum or early neonatal mismanagement