The effect of betamethasone administration to pregnant women on maternal serum indicators of infection

Elevated neutrophil-lymphocyte ratios in extremely preterm neonates with histologic chorioamnionitis

OBJECTIVE

Histologic chorioamnionitis (HCA) is a placental inflammation linked to preterm birth and adverse neonatal outcome. The neutrophil-lymphocyte ratio (NLR) can identify various inflammatory disorders, however its utility in HCA is not clear. Our goal was to examine NLR values and HCA diagnoses in at-risk pregnancies and neonates.

STUDY DESIGN

We retrospectively analyzed the EHR of mothers and preterm (<33 wk GA) neonates with or without HCA (identified by placental histology). The NLR was calculated from complete blood counts in laboring women and in their neonates (0-24 h of life).

RESULT

In 712 consecutive gestations, 50.8% had HCA (26.5% fetal HCA). The neonatal NLR (0-12 h, 13-24 h) predicted fetal HCA better than chance alone (p = 0.01 and 0.002, respectively).

CONCLUSION

Early NLR elevation in preterm neonates is consistent with a diagnosis of fetal HCA. The NLR may identify preterm neonates at risk for HCA-related complications.

Influence of antenatal corticosteroid lung maturation on maternal inflammatory parameters

The aim of this prospective study (Clinical Trials Identifier: NCT02993744) was to detect the effect of fetal lung maturation with betamethasone on the maternal inflammatory parameters C-reactive protein (CRP) and leukocytes. The blood results of 75 patients in the week of gestation (WOG) 23/0 to 34/6 under threat of preterm delivery and treated with betamethasone were analyzed. Sixty-five pregnant women without complications served as control group. Leukocyte numbers increased significantly about 2.4 thsd./µL (±3.3 standard deviation), with a confidence interval of 95% from 1.5 to 3.2 (p < .001). Calculations for CRP were done with logarithmized values. CRP decreased significantly (p < .001) by the factor 0.465, with a 95% confidence interval from 0.376 to 0.576. The results of this study can be used in clinical routine as a decision support, to come to conclusions about inflammatory processes during lung maturation.

Antenatal Corticosteroids: Who Should We Be Treating?

Antenatal corticosteroids remain one of the crucial interventions in those at risk for imminent preterm birth. Therapeutic benefits include reducing major complications of prematurity such as respiratory distress syndrome, intraventricular hemorrhage, and necrotizing enterocolitis, as well as an overall decrease in neonatal deaths. Optimal reductions in neonatal morbidity and mortality require a thoughtful review of the timing of administration. In addition, a thorough understanding is required of which patients maximally benefit from this intervention in the management and counseling of those at risk for preterm birth.

A novel model to study neonatal Escherichia coli sepsis and the effect of treatment on the human immune system using humanized mice

PROBLEM

Neonatal sepsis is a serious threat especially for preterm infants. As existing in vitro and in vivo models have limitations, we generated a novel neonatal sepsis model using humanized mice and tested the effect of Betamethasone and Indomethacin which are used in the clinic in case of premature birth.

METHOD OF STUDY

Humanized mice were infected with Escherichia coli (E. coli). Subsequently, the effect of the infection itself, and treatment with Betamethasone and Indomethacin on survival, recovery, bacterial burden, leukocyte populations, and cytokine production, was analyzed.

RESULTS

The human immune system in the animals responded with leukocyte trafficking to the site of infection and granulopoiesis in the bone marrow. Treatment with Indomethacin had no pronounced effect on the immune system or bacterial burden. Betamethasone induced a decline of splenocytes.

CONCLUSION

The human immune system in humanized mice responds to the infection, making them a suitable model to study neonatal E. coli sepsis and the immune response of the neonatal immune system. Treatment with Betamethasone could have potential negative long-term effects for the immune system of the child.

Maternal leukocytosis after antenatal corticosteroid administration: a systematic review and meta-analysis. J OBSTET GYNAECOL 2017;38:210-216. [PMID: 28903611 DOI: 10.1080/01443615.2017.1342614]

Although it is known that corticosteroid administration causes leukocytosis, the magnitude and length of time this leukocytosis persists is unknown during pregnancy. This study aimed to establish the expected range of maternal leukocytosis in healthy pregnant women at risk for preterm delivery after antenatal corticosteroid administration. PubMed, Embase and ClinicalTrials.gov were searched to identify the studies in healthy women at risk for preterm delivery without signs of clinical infection that reported white blood cell values preceding and after antenatal corticosteroid administration. The inverse variance weighting technique was used to calculate the weighted means and the standard deviation from the mean for each time period. Six studies met inclusion criteria and included 524 patients and 1406 observations. Mean ± standard deviation maternal white blood cell count values prior to antenatal corticosteroid administration and up to 24, 48, 72 and 96 hours after corticosteroid administration were 10.4 ± 2.4, 13.6 ± 3.6, 12.1 ± 3.0, 11.5 ± 2.9 and 11.1 ± 2.5 × 10⁹/L, respectively. Leukocytosis in healthy, non-infected women is expected to peak 24 hours after antenatal corticosteroid administration and the magnitude of increase is small. Impact statement What is already known on this subject: While it is well known that administration of antenatal corticosteroids causes leukocytosis, it is currently unknown the magnitude and length of time the leukocytosis persists. What the results of this study add: This study establishes the expected range and the temporal progression and regression with antenatal corticosteroid administration in healthy pregnant women at risk for preterm delivery without clinical signs of infection. What the implications are of these findings for clinical practice and/or further research: Clinicians may wish to consider further investigation into the clinical cause, whether infectious or non-infectious, for absolute values and changes outside this range.

Effect of Single Dose Betamethasone Administration in Pregnancy on Maternal and Newborn Parameters

INTRODUCTION

Antenatal corticosteroids play an important role in preventing Respiratory Distress Syndrome (RDS) but benefits related to time between corticosteroid administration and delivery need to be explored.

AIM

To observe the effect of betamethasone administration in pregnant women at risk of preterm delivery and on foetal parameters, in terms of development of RDS.

MATERIALS AND METHODS

It was a prospective observational study on pregnant women at risk of preterm delivery who were administered a single dose 24 mg injection betamethasone. Outcome of 111 newborns of enrolled mothers was observed in terms of respiratory distress, Downe's and Silverman Anderson score, need of NICU admission and ventilation. Paired t-test was used to compare means of maternal parameters before and after betamethasone. Independent sample t-test for comparison of scores for respiratory distress in neonates was used.

RESULTS

There was a significant decrease in maternal haematological parameters like mean Red Blood Cell (RBC) and mean Platelet Count (PC) whereas increase in mean Total leucocyte Count (TC) after betamethasone administration. Out of 111 newborn babies, 71 were born within 24 hours and rest were born after 24 hours of betamethasone administration. Twelve out of 71 newborns who were born within 24 hours of betamethasone administration, developed RDS. Mean Downe's score and mean Silverman Anderson score in neonates born within 24 hours of injection administration were significantly higher than those born after 24 hours.

CONCLUSION

Betamethasone administration affects the haematological parameters in mothers in antenatal period nearing term. A minimum of 24 hours have to elapse between corticosteroid administration and delivery of the preterm for benefits to occur.

The Delta Neutrophil Index as a predictive marker of histological chorioamnionitis in patients with preterm premature rupture of membranes: A retrospective study

BACKGROUND

Histological chorioamnionitis (HCA) is related to perinatal morbidity. However, there is no definite diagnostic method for detecting chorioamnionitis before delivery.

METHODS

We evaluated whether the delta neutrophil index (DNI) was an effective early marker of HCA in patients with preterm premature rupture of membranes (PPROM). We retrospectively evaluated 149 women diagnosed with PPROM (gestational age, 20+0 to 36+6 weeks) at Severance Hospital from January 2013 to December 2014. The women were categorized into the following two groups: (a) PPROM without HCA and (b) PPROM with HCA. The maternal white blood cell (WBC) count, neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP) level, and DNI were measured at admission. The DNI has been reported to reflect the fraction of circulating immature granulocytes associated with infection.

RESULTS

Of the 149 patients, 87 were included in the PPROM without HCA group and 62 were included in the PPROM with HCA group. The interval between admission and delivery was significantly shorter in the PPROM with HCA group than in the PPROM without HCA group. There was no significant difference in the maternal WBC count. The serum CRP level, NLR, and DNI were significantly lower in the PPROM without HCA group than in the PPROM with HCA group, while the lymphocyte count was significantly lower in the PPROM with HCA group than in the PPROM without HCA group. A predictive equation was generated by combining the DNI, lymphocyte count, and CRP level, and the sensitivity and specificity for predicting a placental inflammatory response were 69.1% and 70.5%, respectively.

CONCLUSIONS

The DNI could be a predictive marker for HCA in patients with PPROM. Our predictive equation involving the DNI, lymphocyte count, and CRP level may be helpful for predicting the placental inflammatory response in patients with PPROM.

Cystic periventricular leukomalacia in preterm infants: an analysis of obstetric risk factors

OBJECTIVE

To identify obstetric risk factors and to elucidate the effect of prolonged rupture of the membranes on the development of cystic periventricular leukomalacia (PVL) in preterm infants.

METHODS

A retrospective case-control study of 95 preterm infants with the diagnosis of PVL and 245 healthy controls matched for gestational age. A total of 52 antenatal, intrapartum and neonatal characteristics were studied by univariate methods and logistic regression.

RESULTS

Preterm premature rupture of membranes (PPROM) (odds ratio 2.1 [95% CI 1.3-3.4], P=.003), gestational age at PPROM (P=.025), prolonged rupture of membranes (P<.0001), administration of tocolytic agents (1.8 [1.1-3.0], P=.019) and antibiotics (1.9 [1.2-3.1], P=.008) were associated with PVL. The use of tocolytic agents >24 h (P=.008), prolonged latency between the increase in maternal leukocyte count and birth (P=.034), spontaneous onset of labor (1.8 [1.0-2.9], P=.026), vaginal delivery (1.7 [1.1-2.8], P=.029) and male gender (1.5 [1.0-2.0], P=.04) were found more frequently in PVL cases. Preeclampsia (0.4 [0.1-0.9], P=.034), hypertension at booking (P=.009), sonographic IUGR (P=.020), abnormal blood flow of the umbilical artery (P=.032) and cesarean section without labor (0.5 [0.3-0.8], P=.006) were found less frequently. In logistic regression analysis, prolonged rupture of the membranes (P=.748), preeclampsia (P=.973), the use of antibiotics (P=.617) and beta-sympathomimetic tocolytic agents (P=.563) lost statistical significance, whereas birth weight (P=.036) became significant.

CONCLUSION

PPROM and prolonged rupture of the membranes may provoke adverse effects on the neurodevelopmental outcome of the preterm fetus. These findings may have implications on the obstetric management of PPROM beyond 30 weeks of gestation. Cesarean section without labor was less likely associated with the diagnosis of PVL.