512: Prenatal inflammation: an important therapeutic target to prevent adverse outcomes?

target to prevent adverse outcomes? Michal A. Elovitz, Jamie Bastek, Anita Weber, Megan McShea, Markley Foreman, Sindhu Srinivas University of Pennsylvania Perelman School of Medicine, Maternal and Child Research Program; Department of OBGYN, Philadelphia, PA, University of Pennsylvania Perelman School of Medicine, CCEB, Philadelphia, PA, University of Pennsylvania Perelman School of Medicine, Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, Philadelphia, PA OBJECTIVE: Prenatal inflammation, as noted by histological (HCA) or clinical chorioamnionitis (CCA), has been considered a risk factor for prematurity and adverse neonatal outcomes. However, prior studies have been limited by their retrospective nature with more recent studies suggesting that only gestational age at delivery, not the intrauterine environment, is the main predictor of neonatal outcome. We sought to assess if prenatal inflammation, as measured by HCA, CCA or maternal temperature 38 (T38), was associated with adverse neonatal outcomes. STUDY DESIGN: A prospective cohort of women with singleton pregnancies and preterm labor was performed. HCA was determined by a pathologist and CCA by provider. The highest maternal temperature within 24 hours prior to delivery was recorded. Gestational age at delivery (GA-DEL) and neonatal outcomes within the first 30 days of life were recorded. Associations between categorical variables were determined usgin chi-square analyses. MVLR was performed to determine the association between prenatal inflammation (CCA, HCA, T38) on adverse neonatal outcomes (a composite and individualFigure). RESULTS: 595 women and their infants were studied. The PTB rate was 40%. Rates of exposures and outcomes are on Table I. 30% of women with T38 did not have a diagnosis of CCA. GA-DEL was associated with COMP; for each increase in gestational age by 1 week, COMP was decreased by 33% (0.61-.72, P 0.001). HCA was not associated with COMP. In contrast, CCA and T38 were strongly associated with outcomes (FIG 1). Excluding women with CCA, T38 remained associated with adverse outcome (OR 3.5). CONCLUSION: Prenatal inflammation as measured by both CCA and maternal temperature 38 is strongly associated with adverse neonatal outcomes. Whether HCA is a poor marker of intrauterine inflammation or represents a lower risk inflammatory environment than CCA or T38 requires further investigation. These data support the role of prenatal inflammation in adverse neonatal outcomes. Clinical trials that investigate therapies for these mothers/neonates at increased risk should begin. MOD#21FY08-539 513 Antenatal glucocorticoids and postnatal surfactant treatment partially rescues neonatal lethality and pulmonary immaturity in an ERK3-/knockout (ko) murine model of intrauterine growth restriction (IUGR) Milenka Cuevas-Guaman, Elena Sbrana, Cynthia Shope, R. Alan Harris, Stephen Welty, Sylvain Meloche, Kjersti Aagaard Baylor College of Medicine, Department of Pediatrics, Division of Neonatology, Houston, TX, The University of Texas Medical Branch, Obstetrics & Gynecology, Galveston, TX, Baylor College of Medicine, ObstetricsG PNAS 106:16710) but did not rescue neonatal lethality. Using high throughput discovery platforms (whole transcriptome RNA shotgun sequencing), we then identified the critical molecular mediators in fetal pulmonary maturation (i.e., corticotropin releasing hormone (CRH) and surfactant B (SPB)). Here we sought to functionally validate these molecular discoveries in a relevant translational model, hypothesizing that neonatal surfactant (Survanta) with antenatal glucocorticoids could enhance neonatal survival. STUDY DESIGN: In a double crossover design, we administered 0.4mg/kg prenatal dexamethasone (dex) or saline at E16.5 and E17.5, alongside phospholipids-enriched surfactant (Survanta) or saline at 50mg/kg via inhalation intubation at birth. Confirmation of pulmoPoster Session III Doppler Assessment, Fetus, Prematurity www.AJOG.org