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Inflammatory changes in the lungs of premature infants with symptomaticpatent ductus arteriosus
Toshihiko Nakamura1, Jiro Takasaki, Yunosuke Ogawa
1Department of Pediatrics, Saitama MedicalCenter, Saitama Medical School, Kawagoe, Saitama, Japan.
Insights
Indomethacin therapy for symptomatic patent ductus arteriosus (sPDA) in premature infants showed reduced inflammation markers. Successful treatment led to decreased myeloperoxidase and polymorphonuclear leukocytes, alongside increased soluble L-selectin.
Area of Science:
- Neonatal Medicine
- Pediatric Cardiology
- Pharmacology
Background:
- Symptomatic patent ductus arteriosus (sPDA) is a common complication in premature infants.
- Inflammatory processes play a significant role in sPDA and its treatment.
Purpose of the Study:
- To investigate the inflammatory changes during indomethacin therapy for sPDA.
- To analyze biochemical markers in tracheobronchial aspirates and peripheral blood.
Main Methods:
- Analyzed tracheobronchial aspirates (TA) from 11 intubated premature infants.
- Administered three intravenous doses of indomethacin (0.2 mg/kg) with 24-hour intervals.
- Measured myeloperoxidase (MPO), soluble L-selectin (sL-selectin), and polymorphonuclear leukocytes (PMN) before and after treatment.
Main Results:
- Effective sPDA treatment showed significant decreases in peripheral PMN, MPO, and TA PMN, with a significant increase in sL-selectin.
- Non-effective treatment showed non-significant decreases in MPO and PMN in TA, and a significant decrease in sL-selectin.
Conclusions:
- Anti-inflammatory effects after sPDA closure may involve both indomethacin and the ductal closure itself.
- Further research is needed to elucidate the relationship between ductal closure and lung anti-inflammatory actions.
Background:
The aim of the study was to observe the inflammatory changes during the therapy for symptomatic patent ductus arteriosus (sPDA).
Methods:
We investigated biochemically the sample of the tracheobroncheal aspirates (TA) from 11 intubated premature infants. Three i.v. doses of indomethacin (0.2 mg/kg)were administered with 24-h intervals. The samples were divided into two groups, the effective occasions (n = 10)and non-effective occasions (n = 6). The amounts of myeloperoxidase (MPO), soluble L-selectin (sL-selectin)in TA, and the polymorphonuclear leukocytes (PMN) of peripheral blood stream and TA were analyzed before and after treatment ofsPDA with indomethacin.
Results:
In effective occasions, there were significant decreases of peripheral PMN and MPO and PMN in TA. However, this group had a significant increase of sL-selectin. In non-effective occasions, five out of six samples had decreases of MPO and PMNin TA, but not significantly. In contrast, there was a significant decrease of sL-selectin.
Conclusion:
These data suggested that anti-inflammatory change after closure of sPDA may be caused by not only indomethacin itself, but also ductal closure itself. However, further study is necessary to clarify the relationship between the closure of the ductus itself and anti-inflammatory action in the lung.