Systemic inflammation associated with mechanical ventilation among extremely preterm infants

Area of Science:

• Neonatal Medicine
• Pediatric Critical Care
• Immunology

Background:

• Mechanical ventilation is a critical intervention for preterm infants but its association with systemic inflammation is not well-documented.
• Preterm infants are particularly vulnerable to the inflammatory effects of medical interventions.

Purpose of the Study:

• To investigate the relationship between the duration of mechanical ventilation and systemic inflammation markers in very preterm infants.
• To identify specific inflammation-related proteins affected by mechanical ventilation in this vulnerable population.

Main Methods:

• Blood samples were collected on postnatal day 14 from 726 infants born before 28 weeks gestation.
• Concentrations of 25 inflammation-related proteins were measured.
• Multivariable models assessed the association between ventilation duration (categorized as <7 days, 7-13 days, and 14 days) and protein concentrations.

Main Results:

• Infants ventilated for 14 days showed significantly higher concentrations of pro-inflammatory cytokines (IL-1β, TNF-α), chemokines (IL-8, MCP-1), ICAM-1, and MMP-9 compared to those ventilated for <7 days.
• Conversely, 14 days of ventilation was associated with lower concentrations of RANTES, MIP-1β, MMP-1, and VEGF.
• Infants ventilated for 7-13 days exhibited an inflammatory profile similar to those ventilated for 14 days.
• These associations remained significant regardless of chorioamnionitis, antenatal corticosteroid use, or bacteremia.

Conclusions:

• Approximately two weeks of mechanical ventilation in preterm infants is associated with a pro-inflammatory systemic state.
• Prolonged ventilation may lead to elevated levels of inflammatory mediators and reduced levels of potentially protective proteins.
• These findings highlight the potential for mechanical ventilation to contribute to inflammation-mediated organ injury in preterm neonates.