The Relationship Between Maternal Intrauterine Infection With In Flammation Factors Level And Cerebral Injury In Premature Infant

Objective:To investigate the association between cerebral injury inpremature infant with maternal intrauterine infection accompanying inflammation factors level transformation, and further explore the predictive value of inflammation factors level transformation to cerebral injury inpremature infant.Methods:To choose from July 2013 to July 2015 obstetric delivery of premature infants in our hospital. Consecutive premature infants were recruited in Linyi people’s hospital between July,2013 to July,2015.After childbirth take full placenta thickness tissue in the rupture of the placenta membranes and near the umbilical cord, To observe the inflammation of the specimen under the microscope after HE staining and record The degree of leukocyte infiltration in each high power field of vision. According to the pathological results to divided premature intrauterine into infection group (n=114) and the uninfected group (n= 154); Theumbilical vein blood specimen and the whole layer of placenta specimen around the rupture of fetal membrane and umbilical cord were collected before and after the umbilical cord cut separately.The supernatant taken from the blood specimen after centrifugation was used for IL-1β,IL-6,IL-8,TNF-α concentration measurement by enzyme linked immunoassay(ELISA).The inflammation level of the placenta specimenwas observed under the microscope after hematoxylin-eosin staining, and the number of white blood cells per high magnification was recorded.The cerebral ultrasound via anterior sagittal coronal and lateral skull, cranial computed tomography and brain nuclear magnetic resonance were checked during 3 to 7 days after delivery.Results:A total of 268 eligible premature infants were enrolled in this study. The baseline characteristics including gender, gestational age, birth weight and Apgar score were comparable. According to the pathological diagnosis results,114 premature infants occurred maternal intrauterine infection(infection group) and the rest 154 didn’t(uninfection group).(1)The imaging results showed 93 cases occurred cerebral injury,62 cases(54.4%) in infection group and 31 cases in uninfection group.Maternal intrauterine infection increase the risk of cerebral injury inpremature infant nearly 4.7-folds.(OR= 4.73, X2=33.798, P< 0.001).(2)A11 inflammation factors level were significant higher in infection group than in uninfection group, IL-1β(4.98 vs.2.13, p=0.046)、IL-6(6.28 vs.2.16, p=0.028)、 IL-8 (3.27 vs.1.24,p=0.048), TNF-a (4.24 vs.2.27, p=0.038)(3)When the level of IL-1β≥4.30μg/L in umbilical cord blood, the sensitivity was 92.5%, the specificity was 95.4%, the positive predictive value was91.4%, the negative predictive value was 95.9%. When the level of IL-6≥5.20μg/L in umbilical cord blood, the sensitivity was 88.2%, the specificity was 86.9%, the positive predictive value was 78.1%, the negative predictive value was 93.6%. When the level of IL-8≥2.07μg/L in umbilical cord blood, the sensitivity was90.3%, the specificity was 94.7%, the positive predictive value was 84.8%, the negative predictive value was 98.1%.When the level of TNF-α≥2.42μg/L in umbilical cord blood, the sensitivity was 96.8%, the specificity was 88.0%, the positive predictive value was 81.1%, the negative predictive value was 98.1%.Conclusion:(1)Maternalintrauterine infection increases the risk of cerebral injury inpremature infant.(2)the levels of IL-1β, IL-6, IL-8, TNF-a increased when intrauterine infection occurred at present.(3)the levels of IL-1β≥4.30μg/L, IL-6≥5.20μg/L, IL-8≥2.07νg/L, TNF-a ≥2.42μg/L in umbilical cord blood had higher predictive value of premature infant to brain injury.The inflammation factors (IL-1β,IL-6, IL-8, TNF-a) level increase in the umbilical vein blood of intrauterine infection infants and obtain certain predictive value to cerebral injury inpremature infant.