A study on the relationship between placental inflammation, prenatal corticosteroids and early brain injury of preterm infants / 中国新生儿科杂志

ABSTRACT

Objective To study the correlation between histological chorioamnionitis (HCA),prenatal corticosteroids and early brain injury of preterm infants.Method From December 2014 to December 2016,preterm infants with gestational age ≤ 34 weeks admitted to our hospital and umbilical cord blood samples taken immediately after birth were reviewed.According to the results of pathological examination of their mother's placenta and the use of glucocorticoids (GCs),they were assigned into HCA+ GCs + group,HCA + GCs-group,HCA-GCs-group,and HCA-GCs +group.The levels of lnterleukin-6 (IL-6),hepcidin,erythropoietin (EPO),human activin A (ACV-A),S-100β protein,and CC-chemokine ligand 18 (CCL18) in premature infants' umbilical cord blood in each group were tested using ELISA method.The incidences of premature infants' early brain injury and the correlation with inflammatory factors in each group were analyzed.The ROC curve was used to analyze the sensitivity and specificity of S-100β protein and IL-6 level in predicting early brain injury in preterm infants with placenta inflammation.Result A total of 343 infants with gestational age ≤ 34 weeks and their umbilical cord blood samples were tested.Among the 343 premature infants,47.1％ suffered from early brain injury (98/208) in the HCA+ group;while 27.4％ suffered from early brain injury (37/135) in the HCA-group,the difference was statistically significant between the two groups (P ＜ 0.001).A total of 142 cases received prenatal GCs treatment,and 41 (28.9％) cases had early brain injury.201 cases didn't receive prenatal GCs treatment,and 94 (46.8％) had early brain injury.The differences between the two groups were also statistically significant (P=0.001).The incidence of early brain injury in the HCA+GCs-group was significantly higher than the HCA+GCs+ group,HCA-GCs-group and HCA-GCs+ group(P＜0.05).The S-100β protein and IL-6 level in umbilical cord blood of the HCA+GCs-group and HCA+GCs+ group were higher than the HCA-GCs-group(P＜0.05).The area under the ROC curve for IL-6 predicting early brain injury in preterm infants was 0.732 (95％CI 0.675～0.789,P＜0.05).The cut-off value of 213.45 pg/ml of IL-6 (was selected to predict the risk of early brain injury with the sensitivity of 41.9 ％ and the specificity 99.0 ％.The area under the ROC curve for S-100β protein was 0.511 (95％CI 0.449～0.574,P=0.723).Conclusion Placental inflammation and insufficient prenatal glucocorticoids treatment are closely related to the occurrence of early brain injury in preterm infants.S-100β protein and IL-6 in umbilical cord blood may play an important role in early brain injury of premature infants.The IL-6 level has a higher predictive value for early brain injury,while S-100β protein level has a less predictive value.