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The Molecular and Histopathological Assessment of Inflammatory Status in Very and Extremely Premature Infants: A
Claudia Ioana Borțea1, Ileana Enatescu1, Manuela Pantea1
1Department of Neonatology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania.
Insights
Inflammation in extremely preterm infants (EPIs) is higher than in very preterm infants (VPIs), with IL-6 and LDH levels correlating with gestational age and umbilical cord inflammation. Further research is needed to validate findings and develop predictive models.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Immunology
Background:
- Prematurity is associated with significant complications and mortality, often linked to sustained inflammation.
- Understanding the degree and predictors of inflammation in preterm infants is crucial for improving outcomes.
Purpose of the Study:
- To assess inflammation levels in extremely preterm infants (EPIs) and very preterm infants (VPIs).
- To correlate inflammatory markers with umbilical cord (UC) histology and fetal inflammatory response (FIR).
- To identify blood inflammatory markers as predictors of FIR in preterm neonates.
Main Methods:
- Prospective study analyzing 30 preterm neonates (10 EPIs, 20 VPIs).
- Measured IL-6, CRP, and LDH levels at birth and 4 days post-birth.
- Histological examination of umbilical cord (UC) inflammation stages.
Main Results:
- EPIs exhibited significantly higher IL-6 and LDH levels at birth and post-birth compared to VPIs.
- CRP levels increased significantly in EPIs post-birth, while VPIs showed increased CRP exclusively.
- No significant difference in UC inflammation stages between EPIs and VPIs; IL-6 and LDH correlated inversely with gestational age and weight.
Conclusions:
- EPIs demonstrate a more pronounced inflammatory response compared to VPIs, indicated by higher IL-6 and LDH levels.
- Umbilical cord inflammation shows a direct correlation with IL-6 and LDH, but not CRP.
- Larger studies are needed to validate these findings and develop predictive models for preterm labor inflammation.
Abstract:
Prematurity comes with a varying range of complications, implying a high prevalence of complications and mortality and depending on the severity of prematurity and the sustained inflammation among these infants, which recently sparked an important scientific interest. The primary objective of this prospective study was to establish the degree of inflammation in very (VPIs) and extremely preterm infants (EPIs) in association with the histology findings of the umbilical cord (UC), while the secondary objective was to study the inflammatory markers in the neonates' blood as predictors of fetal inflammatory response (FIR). A total of thirty neonates were analyzed, ten of them being born extremely premature (<28 weeks of gestation) and twenty very premature (28-32 weeks of gestation). The EPIs had considerably higher levels of IL-6 at birth than VPIs (638.2 pg/mL vs. 151.1 pg/mL). The CRP levels at delivery did not vary substantially across groups; however, after days, the EPIs had significantly higher CRP levels (11.0 mg/dL vs. 7.2 mg/dL). In contrast, the LDH was considerably higher in the extremely preterm infants at birth and four days after birth. Surprisingly, the proportions of infants with pathologically increased inflammatory markers did not differ between the EPIs and VPIs. The LDH increased considerably in both groups, although the CRP levels increased exclusively among the VPIs. The stage of inflammation in the UC did not vary substantially between the EPIs and VPIs. The majority of infants were identified with Stage 0 UC inflammation (40% in EPI vs. 55% in VPIs). There was a substantial correlation link between gestational age and newborn weight and a significant inverse correlation among gestational age and IL-6 and LDH levels. There was a strong negative association between weight and IL-6 (rho = -0.349) and LDH (rho = -0.261). The stage of the UC inflammation demonstrated a statistically significant direct connection with IL-6 (rho = 0.461) and LDH (rho = 0.293), but none with the CRP. Further studies involving a bigger population size of preterm newborns are required to validate the findings and analyze more inflammatory markers, while prediction models on inflammatory markers that are measured expectantly, before the onset of preterm labor, need to be created.
