Amniotic fluid infection, cytokines, and adverse outcome among infants at 34 weeks’ gestation or less☆
Section snippets
Materials and methods
The study population included 151 women in premature labor and their infants born at less than or equal to 34 weeks’ gestation. Women were admitted to the University of Washington Medical Center, Swedish Medical Center, and Virginia Mason Medical Center in Seattle, Washington, between June 25, 1991, and June 30, 1997. All women provided written informed consent for study participation. The Institutional Review Board of each participating hospital approved the study protocol. Participants were
Results
Microorganisms were recovered from 30 (20%) of 151 AF specimens. Eight AF cultures grew single or mixed anaerobic organisms, and five cultures grew mixed aerobic and anaerobic flora. Ureaplasma urealyticum was isolated from four samples, Escherichia coli from three, Group B Streptococcus from two, Mycoplasma hominis from two, Candida albicans from two, and other aerobic isolates from four.
The AF tumor necrosis factor-α concentration was greater than 30 pg/mL in 21 (81%) of 26 culture-positive
Discussion
Infection of the AF appears to be primarily a fetal, rather than a maternal infection.6, 7 Considerable inflammatory response occurs to AF infection by 26 weeks’ gestation. The median concentration of tumor necrosis factor-α (726 pg/mL) at less than or equal to 26 weeks in infected AF is similar to that in the cerebral spinal fluid of children with meningitis (787 pg/mL) and in the abdominal fluid of adults with peritonitis (400 pg/mL).20, 21
Infants in the positive AF culture and the negative
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This work was supported by National Institutes of Health Grant AI-31071.