Fetal Urine Production Rate in Preterm Premature Rupture of Membranes Is Associated with Adverse Neonatal Outcome: A Pilot Study

Abstract

Aim: In this study, we evaluate the associations between fetal urinary production rate (FUPR), measured by ultrasound, and adverse neonatal outcome in women with preterm premature rupture of membranes (PPROM). Methods: We conducted a prospective pilot cohort of singleton pregnancies complicated by PPROM occurring at gestational week 24 or later managed until spontaneous labor (after 48 h of admission), chorioamnionitis, or induction by protocol at 35 + 0 weeks. FUPR was evaluated by 2D sonography at admission (corrected for gestational age). The main neonatal outcome measures were chorioamnionitis, placental inflammatory grading, first neonatal creatinine value, first neonatal dextrose value, length of neonatal intensive care unit (NICU) stay, necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH) (grades I-IV), blood transfusions, reduced neonatal urine production rate (<4 mL/kg/h), and early neonatal sepsis. Samples of maternal (at admission) and umbilical cord blood were analyzed for interleukin-6 (IL-6) level. Results: The study included 38 women. Low FUPR was associated with clinical chorioamnionitis, longer NICU hospitalization (p = 0.01), higher rates of NEC or IVH (p = 0.008), and blood transfusion (p = 0.004). Conclusions: A finding of FUPR on in utero ultrasound examination in pregnancies complicated by PPROM may be indicative of adverse neonatal outcome.

Reduced fetal urine production rate—An early marker of fetal inflammatory response syndrome in preterm premature rupture of membranes: Prospective cohort study

“…However, studies that correlate FUPR with IL-6 levels are scarce. A study by Avitan et al 8 In our study, the mean IL-6 levels in the FIRS group were significantly higher compared with the Non-FIRS group (77.37 ± 74.51 pg/ ml vs. 5.75 ± 2.80 pg/ml). All 16 patients with histopathologic evidence of FIRS had elevated IL-6 levels.…”

“…However, studies that correlate FUPR with IL‐6 levels are scarce. A study by Avitan et al 8 did not find any correlation between mean fetal IL‐6 levels and FUPR in women with PPROM.…”

“…[12][13][14] On correlating FUPR with neonatal outcomes, it was found that PPROM. 8 The authors reported that the lower FUPR values were associated with clinical chorioamnionitis, longer NICU stay, NEC, intraventricular hemorrhage, and blood transfusion and hence can be used as an early sentinel sign.…”

MicroRNAs miR-4535 and miR-1915-5p in Amniotic Fluid As Predictive Biomarkers for Chorioamnionitis

“…Excess IL-6 levels may lead to neonatal sepsis, periventricular leukomalacia and necrotizing enterocolitis [ 63 ]. In general, IL-6 is a proinflammatory cytokine with functional pleiotropy which plays an important role in host defence; however, uncontrolled or persistent IL-6 production is involved in the development of various inflammatory disorders [ 64 , 65 ]. Furthermore, its regulation is associated with many miRNAs that may also be involved in excess IL-6 secretion [ 66 , 67 ].…”

“Reduced fetal urine production rate – An early marker of fetal inflammatory response syndrome in cases of preterm premature rupture of membranes: A Prospective Cohort Study”

“…The occurrence of RDS, NEC was significantly high in neonates with reducued FUPR as compared to normal FUPR. Only one study had been conducted so far by Avitan et al where they evaluated the association between FUPR and adverse neonatal outcome in patients with PPROM 7 . They found that the lower FUPR values were associated with clinical chorioamnionitis, longer NICU stay, NEC, IVH and blood transfusion and hence can be used as early sentinel sign.…”