DOES ANTENATAL ADMINISTRATION OF 16-METHY LENE-PREDNISOLONE FOR PREVENTION OF RESPIRATORY-DISTRESS SYNDROME INTERFERE WITH MATERNAL PREDICTORS OF INFECTION IN PRETERM LABOR

Silent intrauterine infection is a frequent cause of preterm labour. M aternal C-reactive protein (CRP) and leukocyte count are important pre dictors of such infections. Treatment with corticosteroids is known to elevate leukocyte count and in this manner can possibly interfere wit h its accuracy as a predictor of infection. Therefore, we investigated the impact of antenatal administration of 16-methylene-prednisolone ( Decortilen(R) solubile) on the maternal serum level of CRP and leukocy te count. Furthermore, we determined the haptoglobin, the platelet cou nt as well as the percentage of stab cells and lymphocytes. Patients a nd methods: 20 patients with preterm labour between 25 + 6 and 34 + 2 weeks of gestation were enrolled in a prospective study. Premature rup ture of the membranes, uterine bleeding, infection and treatment with antibiotics were criteria for exclusion. Three doses (60 mg) of Decort ilen(R) solubile were given intravenously 24 h apart. Blood samples we re obtained before, twice a day (8.00 a. m. and p. m.) during treatmen t and until the day 4 after termination of corticosteroid treatment. F or statistical analysis the Wilcoxon rank sum test was used. Results: Before corticosteroid treatment the medians (range) were: CRP: 5.2 (<5 .0-28.0) mg/l, haptoglobin: 1.4 (0.7-2.0) g/l, leukocytes: 10.5 (5.2-1 6.0) G/l, platelets: 246 (128-424) G/l, stabs: 9.5 (3.0-14.0)% and lym phocytes: 28.5 (16.0-50.0)%. During and after termination of corticost eroid administration no significant changes in the CRP and haptoglobin levels were seen. The leukocyte count was unchanged during treatment and decreased on day 1-2 after termination of treatment. The platelet count remained unchanged during corticosteroid treatment and increased significantly thereafter. The stab cell percentage increased slightly from day 1-2 to day 3-4 after termination of treatment. The lymphocyt e percentage increased during treatment and decreased significantly fr om day 1-2 to day 3-4 after treatment. Conclusion: Decortilen(R) solub ile treatment is not associated with an increase in maternal CRP-level and leukocyte count. We emphasise that the accuracy especially of the CRP for early prediction of silent infection in preterm labour does n ot seem to be impaired by this corticosteroid in a dosage usually admi nistered for prevention of respiratory distress syndrome.