AMNIOTIC-FLUID TUMOR-NECROSIS-FACTOR-ALPHA AND THE RISK OF RESPIRATORY-DISTRESS SYNDROME AMONG PRETERM INFANTS

OBJECTIVE: We examined the effect of exposure to amniotic fluid infect ion and cytokines on the pulmonary outcome of preterm infants. STUDY D ESIGN: A cohort of 136 preterm infants born to women in preterm labor had amniotic fluid cultures and tumor necrosis factor-alpha assays per formed. Amniotic fluid was collected by transabdominal amniocentesis. Outcome measures included respiratory distress syndrome and length of oxygen and ventilator support. Logistic regression and Cox proportiona l hazards regression adjusted for birth weight and other confounders. RESULTS: Respiratory distress syndrome developed in 67 (49%) of 136 in fants. Elevated amniotic fluid tumor necrosis factor-alpha levels and amniotic fluid infection were significantly associated with respirator y distress syndrome. This association persisted after adjustment for b irth weight. Infants exposed to tumor necrosis factor-alpha remained o n supplemental oxygen and assisted Ventilation longer and had longer h ospital stays compared with nonexposed infants. CONCLUSION: Prenatal e xposure to tumor necrosis factor-alpha may be a risk factor for respir atory distress syndrome and its complications.