Fetal inflammatory response syndrome linked to poor neonatal outcomes

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1. Infants with fetal inflammatory response syndrome (FIRS) were more likely to be of a lower gestational age and to have lower birth weight at delivery. 

2. FIRS was associated with increased risk of respiratory and neurological morbidity, early-onset sepsis, and death. 

Evidence Rating Level: 2 (Good)  

Study Rundown: This study found that FIRS was associated with increased morbidity and mortality in premature infants. Previous research in this area has been limited by small sample sizes, though other investigations have evaluated the impact of other inflammatory cytokines on single organ systems. This study is the largest to date to assess the impact of IL-6 on multiple organ systems, and its analysis accounted for numerous potential confounders.

Results may not be generalizable outside the Austrian population. Additionally, inclusion of outcomes from only the initial hospitalization may underestimate the odds of adverse outcomes. Future exploration of this topic might include a multi-site study with assessment of long-term health outcomes for infants with FIRS.

Click to read the study in the American Journal of Obstetrics and Gynecology

Relevant Reading: The fetal inflammatory response syndrome

In-Depth [prospective cohort study]: This study analyzed the electronic medical records of 176 premature infants born at a university hospital in Austria to evaluate the association between IL-6 levels in cord blood and neonatal morbidity and mortality. Measures of morbidity include bronchopulmonary dysplasia (BPD), periventricular leukomalacia (PVL), intraventricular hemorrhage (ICH), and early or late onset sepsis.

Infants with adverse outcomes had higher cord levels of IL-6 (median 29.2 pg/ml vs. 5 pg/ml). Furthermore, the odds of any adverse outcome were positively correlated with IL-6 concentration (OR 7.0 for IL-6 >11 pg/ml; OR 9.4 for IL-6 >50 pg/ml; OR 34.9 for IL-6 >500 pg/ml). FIRS, defined as IL-6 >11 pg/ml, was associated with BPD (p<0.001), ICH (p=0.006), early onset sepsis (p=0.018) and death (p=0.004).

By Denise Pong, MPH and Leah Hawkins, MD, MPH

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