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Systemic inflammation associated with mechanical ventilation among extremely preterm infants.

Carl L Bose1, Matthew M Laughon, Elizabeth N Allred

  • 1Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA. cbose@med.unc.edu

Cytokine
|November 15, 2012
PubMed
Summary

Mechanical ventilation for 14 days in preterm infants is linked to higher levels of pro-inflammatory proteins and lower levels of protective proteins, indicating systemic inflammation. Shorter ventilation durations showed less pronounced effects.

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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.