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PGE2/TXB2 imbalance in neonatal hypoxemic respiratory failure
B G Sood1, V Delaney-Black, M Glibetic
1Carman and Ann Adams Department of Pediatrics, Wayne State University, Hutzel Women's Hospital, 3901 Beaubien Blvd., Detroit, MI 48201, USA. bsood@med.wayne.edu
Background:
An imbalance of vaso-constrictor and -dilator mediators has been implicated in the pathogenesis of the pulmonary hypertension accompanying neonatal hypoxemic respiratory failure (NHRF).
Aim:
To characterize plasma PGE2, TXB2 and their ratio in normal newborns and in those with NHRF.
Methods:
Twenty newborns with NHRF received inhaled PGE1 (IPGE1) by jet nebulizer in doses of 25, 50, 150 and 300 ng/kg/min followed by weaning. Blood for PGE2 and TXB2 assay using EIA was available in 8 neonates with NHRF prior to IPGE1. Umbilical cord arterial samples were also obtained at delivery from 10 normal newborns to serve as controls.
Results:
Compared to normal newborns, those with NHRF had significantly lower PGE2/TXB2 ratios after controlling for preterm gestation (< 37 weeks) and postnatal age (p < 0.05). Notably, all subjects except one in the NHRF group had a value of < 1.0 (range 0.1-1.2) compared to a value of > 1.0 in all subjects in the Control group (range 1.1-5.2).
Conclusions:
Lower PGE2/TXB2 ratio in subjects with NHRF compared with controls reflects a predominance of vaso-constrictor activity in these patients as the basis of pulmonary hypertension. Plasma PGE2/TXB2 ratio may have important implications for the diagnosis and treatment of NHRF.
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