Impaired Whole-Blood Polymorphonuclear LeukocyteMigration as a Possible Predictive Marker for Infections in Preterm Premature Rupture of Membranes

[摘要] Objectives:Steroids, used in pretermpremature rupture of membranes (pPROM), to reduce the risk of morbidityand mortality of the preterm neonate, impair the maternal polymorphonuclear leukocyte (PMN)-based immunesystem. In spite of combination with antibiotics, prenatal and postnatal bacterial infections of mother and child arefrequent. This pilot study focuses on the influence of steroids in pPROM on maternal PMN functional capacity andsubsequent infections.Methods:After opting for expectant management, eight women with pPROM and no signs of infection weretreated by steroids (betamethasone 5.7 mg, i.m. every 24 hours, for three days) and antibiotic therapy with eitheramoxicillin and clavulanic acid, piperacillin or ampicillin i.v. up to delivery. The conventional inflammation parametersof PMN blood count and C-reactive protein (CRP) were measured daily in parallel with PMN migratorycapacity towards N-formyl-methionyl-leucyI-phenylalanine stimulation and under blank conditions, estimated by awhole blood membrane filter assay.Results:In all patients PMN migration decreased during the application of steroids. Three patients showeda decrease in PMN migration below critical values and in spite of antibiotic prophylaxis acute pyelonephritisdeveloped 2–6 days later. PMN count and CRP were not predictive of maternal infection.Conclusion:Reduced PMN function, caused by steroid treatment in pPROM, is suggested to be a reason for seriousbacterial infections in spite of antibiotic prophylaxis. PMN migration reflects individual PMN defensive capacity.

[学科分类] 妇产科学