The relationship among inflammatory lesions of the umbilical cord (funisitis), umbilical cord plasma interleukin 6 concentration, amniotic fluid infection, and neonatal sepsis

OBJECTIVE: The purpose of this study was to determine whether funisitis (in flammation of the umbilical cord detected by histologic examination of the placenta) is associated with changes in the umbilical cord plasma concentra tion of interleukin 6, microbial invasion of the amniotic cavity, and neona tal sepsis. STUDY DESIGN: The relationship among the presence of funisitis, interleukin 6 concentrations in umbilical cord plasma at birth, the results of amnioti c fluid culture performed within 3 days of birth, and the occurrence of con genital neonatal sepsis was examined in 315 consecutive singleton preterm b irths (20-35 weeks' gestation). Funisitis was diagnosed in the presence of neutrophil infiltration into the umbilical vessel walls or Wharton jelly. T he interleukin 6 concentration was measured with a specific immunoassay. Am niocentesis was performed in 106 patients within 3 days of birth. Amniotic fluid was cultured for aerobic and anaerobic bacteria and for mycoplasmas. RESULTS: (1) Funisitis wars present in 25% of patients (78/315). (2) Patien ts with funisitis had a significantly higher median cord plasma interleukin 6 and a lower gestational age at birth than did those without funisitis (c ord interleukin 6: median, 52.4 pg/mL; range, 0.9-19,230 pg/mL; vs median, 4.6 pg/mL; range, 0-18,108 pg/mL; gestational age: median, 31.1 weeks' gest ation; range, 21.0-35.0 weeks' gestation; vs median, 32.9 weeks' gestation: range, 21.4-35.0 weeks' gestation; P < .001 for each comparison). (3) A co rd plasma interleukin 6 of <greater than or equal to>17.5 pg/mL had a sensi tivity of 70% and a specificity of 78% in the identification of funisitis. (4) Microbial invasion of the amniotic cavity and clinical chorioamnionitis were more common among patients with funisitis than among those without fu nisitis (positive amniotic fluid culture: 53% [20/38]: vs 12% [8/68]; clini cal chorioamnionitis: 18% [14/78]; vs 4% [9/237]; P < .001 for each compari son). (5) Neonates with funisitis had a significantly higher rate of congen ital sepsis than did those without this lesion (12% [8/66] vs 1% [3/216]; P < .001); this difference remained significant after adjustment for gestati onal age at birth (odds ratio, 7.2; 95% confidence interval, 1.8-29.0). CONCLUSION: (1) Umbilical cord plasma interleukin 6 concentrations were hig her in neonates born with funisitis than in those without this lesion. (2) Funisitis is associated with amniotic fluid infection, congenital neonatal sepsis, and the fetal inflammatory response syndrome.