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Energy expenditure and plasma catecholamines in preterm infants with mild chronic lung disease
Jacqueline Bauer1, Kathrin Maier, Bernd Muehlbauer
1Division of Neonatology, Department of Pediatrics, University of Heidelberg, Im Neuenheimer Feld 150, D-69120 Heidelberg, Germany. Jaqueline_Bauer@med.uni-heidelberg.de
Insights
Preterm infants with mild chronic lung disease (CLD) showed increased energy expenditure and elevated serum catecholamines, indicating significant physiological stress during early disease stages.
Area of Science:
- Neonatology
- Pediatric Pulmonology
- Physiology
Background:
- Chronic lung disease (CLD) is a significant concern in preterm infants.
- The physiological stress response in infants developing CLD is not fully understood.
- Energy expenditure (EE) and stress markers like catecholamines are crucial indicators of infant health.
Purpose of the Study:
- To investigate if energy expenditure (EE) increases during the development of chronic lung disease (CLD) in preterm infants.
- To assess serum catecholamine levels as indicators of physiological stress in infants with developing CLD.
- To explore the relationship between EE, catecholamines, and other physiological parameters in preterm infants at risk for CLD.
Main Methods:
- Study included 16 preterm infants (28-34 weeks gestation), with 8 at risk for CLD and 8 healthy controls.
- Indirect calorimetry measured EE weekly from postnatal weeks 2 to 5.
- Serum adrenaline and noradrenaline concentrations were quantified using high-pressure liquid chromatography (HPLC).
Main Results:
- Preterm infants who developed mild CLD exhibited significantly increased EE from week 3 (+67%) to week 5 (+46%) compared to controls.
- Plasma noradrenaline levels were significantly elevated in CLD infants at weeks 3, 4, and 5.
- Plasma adrenaline was markedly higher in the CLD risk group from week 2 to 5, suggesting substantial stress.
Conclusions:
- Preterm infants with mild CLD experience significant physiological stress, evidenced by elevated plasma catecholamines.
- Increased energy expenditure in these infants may be partly attributed to this stress response.
- These findings highlight the importance of monitoring EE and stress markers in preterm infants at risk for CLD.
Abstract:
The present study examined the hypothesis that the energy expenditure (EE) increases during the development of chronic lung disease (CLD) together with serum catecholamines as indicator of stress. Sixteen spontaneously breathing infants with gestational age of 28-34 weeks and birth weight of 870-1920 g were studied. Eight patients were at risk for CLD, eight were healthy controls. Measurements of indirect calorimetry were done weekly at postnatal ages of 2, 3, 4 and 5 weeks. Serum concentrations of adrenaline and noradrenaline were measured by means of a high-pressure liquid chromatography (HPLC) method. The eight CLD risk infants developed mild CLD with FiO(2) of 0.27-0.31 and characteristic radiographic signs at 28 days. Compared to the healthy controls, preterm infants with mild CLD showed increases in EE from week 3 (+67%) to week 5 (+46%). Plasma noradrenaline was increased significantly in the CLD infants when compared to the controls at week 3 (0.7+/-0.3 vs. 0.5+/-0.1 ng/ml; P<0.05) and more pronounced at week 4 (1.4+/-0.2 vs. 0.6+/-0.2 ng/ml; P<0.001) and 5 (1.1+/-0.3 vs. 0.7+/-0.2 ng/ml; P<0.01). Plasma adrenaline was markedly higher in the CLD risk group (mean overall value: 0.64+/-0.1 ng/ml) than in the controls (<0.1 ng/ml in all controls) from week 2 to 5. Regression analysis for the combined values of the infants with and without CLD showed that EE was directly correlated with heart rate, noradrenaline and adrenaline concentration at each of the four study weeks and with respiratory rate at weeks 2 and 3. Increased plasma catecholamine concentrations in preterm infants with CLD suggest that these infants experienced marked stress during the early stages of the disease. Increased EE may in part be a result of this stress.