Components of the systemic fetal inflammatory response syndrome as predictors of impaired neurologic outcomes in children

Mittendorf, Robert MD, DrPH
Montag, Anthony G. MD
MacMillan, William MD
Janeczek, Susan DO
Pryde, Peter G. MD
Besinger, Richard E. MD
Gianopoulos, John G. MD
Roizen, Nancy MD

Maywood and Chicago, Ill, Madison, Wis, and Syracuse, NY
From the ^aDepartment of Obstetrics and Gynecology, Loyola University Medical Center,
^bthe Department of Pathology, University of Chicago,
^cthe Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin,
^dand the Division of Developmental Pediatrics, Department of Pediatrics, State University of New York, Upstate Medical University.

Supported by the United Cerebral Palsy Research and Educational Foundation, Washington, DC.

Presented as Merit Award paper at the Sixty-Ninth Annual Meeting of the Central Association of Obstetricians and Gynecologists, October 27-30, 2002, Las Vegas, Nev.

Reprint requests: Robert Mittendorf, MD, General Division, Department of Obstetrics and Gynecology, Loyola University Medical Center, 2160 S First Ave, Maywood, IL 60153.

E-mail:[email protected]

American Journal of Obstetrics and Gynecology 188(6):p 1438-1446, June 2003.

OBJECTIVE:

The purpose of this study was to compare interleukin-6 and funisitis as predictors of impaired neurologic outcomes in children by performing a secondary analysis on data that were collected prospectively for another purpose.

STUDY DESIGN:

We examined umbilical cords for funisitis and obtained cord blood for interleukin-6 levels. A psychomotor developmental index score was determined for each child at age 18 months.

RESULTS:

The prevalence (46%) of elevated interleukin-6 levels (>= 10 pg/mL) among children with low psychomotor developmental index scores (<100) was not significantly different from that of children with normal scores (47%). Among children with funisitis (n = 21), the median psychomotor developmental index score was 94; for children without funisitis (n = 92), it was 99 (P < .02). When the data were regressed for confounding, funisitis remained significant (adjusted odds ratio, 1.3; 95% CI, 1.1-1.9). Furthermore, funisitis was a more specific predictor of low psychomotor developmental index scores (P < .001), although elevated interleukin-6 levels were more sensitive.

CONCLUSION:

When used for the prediction of impaired neurologic outcomes in children, funisitis has better specificity and thus a better positive predictive value than does interleukin-6. (Am J Obstet Gynecol 2003;188:1438-46.)