Cerebral Intraventricular Hemorrhage and Interleukin-6 in Preterm Neonates

Document Type: Original Article

Authors

1 Neonatal and Child Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran.

2 North Khorasan University of Medical Sciences, Bojnurd, Iran.

3 Subspecialty of Pediatric Infectious Diseases, Gorgan, Iran.

4 Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Background: Intraventricular hemorrhage (IVH) in preterm neonates is a serious problem in neonatal intensive care units (NICU) worldwide. IVH is reported in approximately 60-70% of very-low-birth-weight (VLBW) neonates. The present study aimed to assess the association of IVH with neonatal characteristics and serum markers, such as serum Interleukin-6 (IL-6) level, in preterm neonates in an academic hospital in the Northeast of Iran.
Methods: In this cross-sectional study, a number of 71 VLBW preterm neonates (≤34 weeks of gestational age (GA), birth weight (BW) ≤1500g) were examined regarding the evidence of IVH up to the 40th week of GA in Gorgan, Northeast of Iran. The serum interleukin-6 (IL-6) level was measured within the first 12 hours of lifebirth. The association among the variables was analyzed in SPSS software (version 16) using the chi-square test.
Results: Out of 56 preterm neonates who survived until the 40th week, 15 (26.8%) cases demonstrated evidence of IVH at discharge, they had a significantly lower GA (29.04±2 weeks vs. 30.44±1.7 weeks; P=0.003) and BW (1075.43±208 kg vs. 1251.6±199.4 kg; P=0.001), as compared to 41(73.2%) newborns with no IVH. Preterm neonates with IVH had a significantly higher IL-6 serum level, as compared to those without IVH (224±210 pg/ml vs. 91.93±138 pg/ml; P=0.035).
Conclusion: As evidenced by the obtained result, low birth weight and premature birth could be serious risk factors for the development of IVH. Furthermore, IL-6 concentration may play a pivotal role in the occurrence of IVH.

Keywords


1. Bassan H. Intracranial hemorrhage in the preterm infant: understanding it, preventing it. Clin Perinatol. 2009; 36(4):737-62.
2. Ment LR, Bada HS, Barnes PE, Grant PE, Hirtz D, Papile L, et al. Practice parameter: neuroimaging of the neonate: report of the quality standards subcommittee of the American academy of neurology and the practice committee of the child neurology society. Neurology. 2002; 58(12):1726-38.
3. Mercer JS, Vohr BR, McGrath MM, Padbury JF, Wallach M, Oh W. Delayed cord clamping in very preterm infants reduces the incidence of intracranial hemorrhage and late-onset sepsis: a randomized, controlled trial. Pediatrics. 2006; 117(4):1235-42.
4. Volpe JJ. Intracranial hemorrhage: germinal matrix-intracranial hemorrhage. Neurology of the newborn. 5th ed. Philadelphia: Saunders Elsevier; 2008.
5. Annibale DJ, Hill J. Periventricular hemorrhage–intracranial hemorrhage. Available at: URL: www emedicine; 2008.
6. Wilson-Costello D, Friedman H, Minich N, Fanaroff AA, Hack M. Improved survival rates with increased neurodevelopmental disability for extremely low birth weight infants in the 1990s. Pediatrics. 2005; 115(4):997-1003.
7. Heuchan AM, Evans N, Henderson Smart DJ, Simpson JM. Perinatal risk factors for major intracranial haemorrhage in the Australian and New Zealand Neonatal Network, 1995-97. Arch Dis Child Fetal Neonatal Ed. 2002; 86(2):F86-90.
8. Jain NJ, Kruse L, Demissie K, Khandelwal M. Impact of mode of delivery on neonatal complications: trends between 1997 and 2005. J Matern Fetal Neonatal Med. 2009; 22(6):491-500.
9. Ballabh P. Intracranial hemorrhage in premature infants: mechanism of disease. Pediatr Res. 2010; 67(1):1-8.
10. Kuperman AA, Kenet G, Papadakis E, Brenner B. Intracranial hemorrhage in preterm infants: coagulation perspectives. Semin Thromb Hemost. 2011; 37(7):730-6.
11. Sorokin Y, Romero R, Mele L, Wapner RJ, Iams JD, Dudley DJ, et al. Maternal serum interleukin-6, C-reactive protein, and matrix metalloproteinase-9 concentrations as risk factors for preterm birth 12. Heep A, Behrendt D, Nitsch P, Fimmers R, Bartmann P, Dembinski J. Increased serum levels of interleukin 6 are associated with severe intracranial haemorrhage in extremely premature infants. Arch Dis Child Fetal Neonatal Ed. 2003; 88(6):F501-4.
13. Kassal R, Anwar M, Kashlan F, Simulian J, Hiatt M, Hegyi T. Umbilical vein interleukin-6 levels in very low birth weight infants developing intracranial hemorrhage. Brain Dev. 2005; 27(7):483-7.
14. Salonvaara M, Riikonen P, Kekomäki R, Vahtera E,

Mahlamäki E, Halonen P, et al. Effects of gestational age and prenatal and perinatal events on the coagulation status in premature infants. Arch Dis Child Fetal Neonatal Ed. 2003; 88(4):319-23.
15. Whitelaw A. Intracranial haemorrhage and posthaemorrhagic hydrocephalus: pathogenesis, prevention and future interventions. Semin Neonatol. 2001; 6(2):135-46.
16. Tauscher MK, Berg D, Brockmann M, Seidenspinner S, Speer CP, Groneck P. Association of histologic chorioamnionitis, increased levels of cord blood cytokines, and intracerebral hemorrhage in preterm neonates. Biol Neonate. 2003; 83(3):166-70.
17. Yoon BH, Jun JK, Romero R, Park KH, Gomez R, Choi JH, et al. Amniotic fluid inflammatory cytokines (interleukin-6, interleukin-1 beta, and tumor
necrosis factor-alpha), neonatal brain white matter lesions, and cerebral palsy. Am J Obstet Gynecol. 1997; 177(1):19-26.
18. Cekmez F, Tanju IA, Canpolat FE, Aydinoz S, Aydemir G, Karademir F, et al. Mean platelet volume in very preterm infants: a predictor of morbidities? Eur Rev Med Pharmacol Sci. 2013; 17(1):134-7.
19. Deulofeut R, Sola A, Lee B, Rogido M. Delivery room cardiopulmonary resucitation of very preterm infant is associated with adverse short- and long-term outcomes. A Pediatr (Barc). 2007; 66(1):31-7.
20. Dani C, Poggi C, Barp J, Berti E, Fontanelli G. Mean platelet volume and risk of bronchopulmonary dysplasia and intracranial hemorrhage in extremely preterm infants. Am J Perinatol. 2011; 28(7):551-6.