Mediators of fetal inflammation in extremely low gestational age newborns

To establish levels of mediators of inflammation in cord blood and postnata l serum from extremely low gestational age newborns (ELGANs, less than or e qual to 28 weeks), we measured sixteen markers of inflammation by recycling immunoaffinity chromatography in 15 ELGANs who had serum sampled at days 2 -5. Median levels of IL-1, IL-6, IL-8, IL-11, IL-13, TNF-alpha, G-CSF, M-CS F, GM-CSF, MTP-1 alpha, and RANTES mere considerably higher than published values of these inflammatory mediators from term newborns. In three of eigh t ELGANS who had serial measurements taken, levels of IL-1, IL-6, IL-8, IL- 11, TNF-alpha, G-CSF, and MIP-1 alpha declined from initially very high lev els to reach an apparent baseline towards the end of the first postnatal we ek. In these same three infants, GM-CSF and TGF-beta1 levels increased cont inuously during the first week. In the other five ELGANs, no consistent cha nges were observed, We speculate, that in some ELGANs, a fetal systemic inf lammatory response is characterized by an antenatal wave of pro-inflammator y cytokines, followed by a second, postnatal wave of anti-inflammatory cyto kines. Large epidemiologic studies are needed to clarify relationships amon g inflammation markers and their expression in the fetal and neonatal circu lation over time. Such studies would also add to our understanding of the p ossible role of inflammatory mediators in the pathophysiology of the major complications of extreme prematurity. (C) 2001 Academic Press.