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IL-6 Predicts Poor Early Post-Natal Growth in Very Low-Birth-Weight Infants in a Low-Middle Income Setting
Cheryl Anne Mackay1, James Stephanus Smit1, Farhaad Khan1
1Department of Paediatrics, Dora Nginza Hospital, Nelson Mandela Bay, Port Elizabeth 6070, South Africa.
Insights
Extra-uterine growth restriction (EUGR) is common in preterm infants. Elevated interleukin-6 (IL-6) in cord blood is linked to growth restriction at 40 weeks but not 12 months postmenstrual age.
Area of Science:
- Neonatalogy
- Pediatric Growth
- Inflammatory Cytokines
Background:
- Extra-uterine growth restriction (EUGR) is a frequent complication in preterm infants.
- Elevated pro-inflammatory cytokines are suspected contributors to EUGR.
Purpose of the Study:
- To assess postnatal growth in very low-birth-weight (VLBW) infants.
- To investigate the association between cord blood levels of interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) and infant growth at 40 weeks and 12 months postmenstrual age (PMA).
Main Methods:
- A prospective cohort study enrolled infants with birth weight <1500g.
- Umbilical cord blood was collected for IL-6 and TNF-α analysis.
- Infants were monitored for anthropometric measurements up to 12 months PMA.
Main Results:
- Significant EUGR was observed, affecting over 90% of infants for weight and length at 40 weeks PMA.
- Elevated IL-6 levels were significantly associated with restricted weight and length at 40 weeks PMA.
- No significant association was found between IL-6 and growth at 12 months PMA, nor between TNF-α and growth at either time point.
Conclusions:
- The study confirms high rates of EUGR in VLBW infants.
- Elevated IL-6 in cord blood is a potential early indicator of growth restriction in preterm infants, but this association diminishes by 12 months PMA.
Background:
Extra-uterine growth restriction (EUGR) is common in preterms and may be associated with elevated pro-inflammatory cytokines.
Objective:
Describe postnatal growth in a cohort of very low-birth-weight (VLBW) infants and determine the association of interleukin-6 (IL-6) and tumour necrosis factor alpha (TNF-α) in umbilical cord blood with growth at 40 weeks and 12 months postmenstrual age (PMA).
Methods:
Single-centre, prospective cohort study conducted from 1 June 2017 to 31 January 2019 with follow-up to 31 March 2020. Infants <1500 g at birth were enrolled, cord blood collected for IL-6 and TNF-α assays and postnatal care, including anthropometry, provided to 12 months PMA. Informed consent and ethics approval were obtained.
Results:
In total, 279 patients were enrolled; 84 (30.1%) died before 12 months and 91 (32.6%) lost to follow-up. Anthropometry was available for 151 infants at 40 weeks and 105 at 12 months. Z-Scores at 40 weeks for males and females combined were -2.5, -2.1 and -1.2 for weight, length and head circumference. EUGR occurred in 103/113 (91.2%), 98/107 (91.6%) and 70/109 (64.2%) participants for weight, length and head circumference. Elevated IL-6 was associated with restricted weight (56.0 vs. 14.5 pg/ml, p = 0.02) and length (60.4 vs. 7.3 pg/ml, p = 0.01) at 40 weeks. There was no difference in IL-6 at 12 months and no difference in TNF-α at 40 weeks or 12 months.
Conclusion:
The study reports significant EUGR. Elevated IL-6 was associated with growth restriction at 40 weeks but not 12 months PMA.
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