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Le syndrome de réponse inflammatoire fœtale : définition, causes et conséquences

  • T. Debillon
  • P. Hoffman
  • F. Cneude
  • P. Andrini
Mise Au Point / Update
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Résumé

Les infections intra-utérines ou les ruptures prématurées des membranes peuvent favoriser une synthèse de cytokines pro-inflammatoires. Le terme de « syndrome de réponse inflammatoire fœtale » (SPIF) est utilisé pour dénommer cette réponse immune du fœtus. Plusieurs moyens permettent de reconnaître le SRIF durant la vie fœtale ou à la naissance : élévation de l’interleukine (IL)-6 dans le sang du cordon, funiculite constatée à l’examen histologique du cordon ou petite taille du thymus fœtal évalué par échographie. Chez le prématuré, un lien significatif entre morbidité néonatale et SRIF a été identifié, puisqu’une élévation de l’IL-6 dans le sang du cordon ou dans le liquide amniotique est constatée chez les enfants qui développeront ultérieurement une leucomalacie périventriculaire, une dysplasie bronchopulmonaire ou une infirmité motrice cérébrale. Prévenir la morbidité néonatale liée au SRIF est un enjeu majeur en néonatologie. Dans les situations à risque, comme les ruptures prématurées des membranes, les corticoïdes en anténatal, l’antibiothérapie maternelle et l’attitude obstétricale (prolongation de la grossesse ou extraction fœtale) doivent être discutés.

Mots clés

Interleukine Morbidité néonatale Inflammation fœtale 

Foetal inflammatory response syndrome: definition, etiology and consequences

Abstract

Fetal inflammatory response syndrome (FIRS) is caused by stimulation of the foetal immune system and biosynthesis of pro-inflammatory cytokines in the human foetus following intra uterine infection and/or premature membrane rupture. Several diagnostic features characterise FIRS during foetal life or at birth, including elevated levels of interleukin-6 in the cord blood, histological funiculitis or small foetal thymus size measured by ultrasound. A relationship between neonatal morbidity and foetal inflammation has been demonstrated by the increased concentration of IL-6 in cord blood or amniotic fluid in children who develop periventricular leukomalacia, bronchopulmonary dysplasia or cerebral palsy. Preventing adverse neonatal outcome associated with FIRS is a real challenge for neonatology. In at risk situations, such as premature rupture of membranes, maternal glucocorticoids, antibiotic therapy and the obstetric point of view (whether to continue with the pregnancy or extract the foetus) must be discussed.

Keywords

Interleukin Neonatal Morbidity Foetal Inflammation 

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Copyright information

© Springer 2009

Authors and Affiliations

  • T. Debillon
    • 1
  • P. Hoffman
    • 2
  • F. Cneude
    • 1
  • P. Andrini
    • 1
  1. 1.Clinique universitaire de médecine et réanimation néonataleCHU de GrenobleGrenoble cedex 09France
  2. 2.Clinique universitaire de gynécologie obstétriqueCHU de GrenobleGrenoble cedex 09France

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