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From the second trimester to near term, fetuses in utero can swallow up to 500–1000 ml amniotic fluid a day, which assists in normal development of the gastrointestinal system.1,2 The aims of this study were to determine whether the concentration of gastric interleukin 6 (IL6) immediately after birth was associated with funisitis, the histological hallmark of fetal inflammatory response syndrome,3 and whether measuring the gastric IL6 concentration would be an effective method for identifying funisitis.
In a prospective pilot study conducted at the Ulsan University Hospital in South Korea between November 2002 and August 2003, 59 newborns at <35 weeks gestation and their mothers were investigated for gastric IL6 concentrations at birth and the presence of funisitis and chorioamnionitis. Fetal gastric fluids were aspirated at the time of delivery with a 5F orogastric feeding tube and clarified by centrifugation at 20 000 g for 10 minutes at room temperature. Gastric IL6 concentrations were measured by immunoassay (Becton Dickinson Pharmingen, San Diego, California, USA), and the presence of funisitis and chorioamnionitis were diagnosed based on histological examination according to the criteria given by Salafia et al.4
Seven umbilical cords (12%) were identified as having funisitis. All patients with funisitis had chorioamnionitis. Twenty two placentas (37%) showed chorioamnionitis only (without funisitis). Thirty patients (51%) had no evidence of neutrophilic infiltration in membranes and umbilical cords. Babies associated with funisitis were less mature, weighed less, and had a lower five minute Apgar score at birth than those not associated with funisitis (table 1). Of seven infants whose umbilical cords showed funisitis, six had raised (defined as ⩾30 ng/ml) gastric aspirate IL6 concentration. In contrast, only two of 52 infants without funisitis had raised gastric IL6 (p<0.001). The median gastric IL6 concentrations were 167.9 ng/ml (range 0.1–326.8) in the funisitis group and 1.5 ng/ml (range 0.1–54.4) in the non-funisitis group (2.3 ng/ml (range 0–54.4) in the chorioamnionitis only group and 1.5 ng/ml (range 0.1–38.8) in the control group) (fig 1).
Although these are preliminary data, our results suggest that the measurement of IL6 concentration in gastric aspirate in premature infants immediately after birth may be a safe and effective method for identifying intrauterine infection of fetuses, such as cordocentesis.5 Further research in a larger number of study subjects should be considered to clarify the association of gastric cytokine with funisitis.
This study was supported by the 2003 Research Fund of the University of Ulsan.
Competing interests: none declared
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