GRANULOCYTE AND GRANULOCYTE-MACROPHAGE COLONY-STIMULATING FACTORS IN CORD AND MATERNAL SERUM AT DELIVERY

Impaired neutrophil responses contribute to the neonate's increased su sceptibility to infection. Because granulocyte colony-stimulating fact or (G-CSF) and granulocyte-macrophage colony-stimulating factor (GM-CS F) enhance granulocyte and macrophage number and function, their use i n the management of neonatal sepsis may be beneficial. Little is known about the endogenous levels of G-CSF and GM-CSF. In adults, raised va lues for G-CSF, but not GM-CSF, have been demonstrated in patients wit h infection, and conflicting data has emerged regarding CSF levels in neonates. We have used an ELISA to measure maternal and cord serum G-C SF and GM-CSF at the time of delivery, with gestational age between 25 and 42 wk. In mothers, an inverse linear relationship between gestati onal age and GM-CSF levels (p = 0.049) was found, but no association w ith G-CSF levels was observed. In neonates, a quadratic association wa s found between GM-CSF levels and gestational age (p = 0.019), whereas G-CSF levels showed an inverse linear association (p = 0.015). In add ition, an association was found between maternal and cord GM-CSF (p = 0.007) but not G-CSF levels in paired samples. The effect of gestation al age on the cytokine levels could not be explained by the white cell count, the absolute neutrophil count, pregnancy-induced hypertension, or the presence of infection. We suggest that 1) GM-CSF levels in mot hers vary throughout gestation and may have a role in the maintenance of normal pregnancy; 2) G-CSF and GM-CSF levels in neonates vary with gestational age and may have a developmental role; and 3) G-CSF has th eoretical benefit in the management of neonatal neutropenia and sepsis ; clinical trials rue now needed to establish its optimal use.