Impaired Whole‐Blood Polymorphonuclear Leukocyte Migration as a Possible Predictive Marker for Infections in Preterm Premature Rupture of Membranes

Abstract

Objectives: Steroids, used in preterm premature rupture of membranes (pPROM), to reduce the risk of morbidity and mortality of the preterm neonate, impair the maternal polymorphonuclear leukocyte (PMN)-based immune system. In spite of combination with antibiotics, prenatal and postnatal bacterial infections of mother and child are frequent. This pilot study focuses on the influence of steroids in pPROM on maternal PMN functional capacity and subsequent infections. Methods: After opting for expectant management, eight women with pPROM and no signs of infection were treated by steroids (betamethasone 5.7 mg, i.m. every 24 hours, for three days) and antibiotic therapy with either amoxicillin and clavulanic acid, piperacillin or ampicillin i.v. up to delivery. The conventional inflammation parameters of PMN blood count and C-reactive protein (CRP) were measured daily in parallel with PMN migratory capacity towards N-formyl-methionyl-leucyI-phenylalanine stimulation and under blank conditions, estimated by a whole blood membrane filter assay. Results: In all patients PMN migration decreased during the application of steroids. Three patients showed a decrease in PMN migration below critical values and in spite of antibiotic prophylaxis acute pyelonephritis developed 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 serious bacterial infections in spite of antibiotic prophylaxis. PMN migration reflects individual PMN defensive capacity.

Determinants of Pathology in Light‐irradiated Cells

“…An accelerated release of newly formed PMN cells from the bone marrow is known as a common feature of the systemic response to an inflammatory stimulus (16–18). Our assumption is in line with other reports indicating that PMN migration and ROS release, rather than PMN count, reflect PMN cell activity (19–21; G. Egger, personal communication); moreover, our results are in accord with an observation that ROS release negatively correlated with PMN migration (22). PMN counts can be beneficially employed for group analysis and evaluation of group behavior (1).…”

Differential effects of antibiotics in combination with G-CSF on survival and polymorphonuclear granulocyte cell functions in septic rats

“…Antimicrobial PMN functions, namely the migratory activity and superoxide production are differently regulated. In obstetric patients without antibiotic treatment reduced PMN migration was predictive for infections in cases of preterm premature rupture of membranes [ 25 ]. From the literature it is known that G-CSF stimulates cellular immune defence mechanisms and alters the cytokine network.…”

Dysfunction of innate immunity and associated pathology in neonates

“…76 Reduced neutrophil migration has been suggested as a reason for the serious bacterial infections seen in preterm neonates despite antibiotic prophylaxis in the mother. 77 In addition to the disadvantages with respect to the phagocytic activity of neutrophils, neonates, especially those born prematurely, have an age-specific diminution of opsonins such as fibronectin, immunoglobulins, and complement including mannose-binding lectin, 78,79,80,81,82 Deficiency of such opsonins impairs the neutrophils' phagocytic capacity in neonates. 63,83 Moreover, neutrophils, especially from immature neonates have variable in vitro efficiency in killing certain bacteria.…”