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Pulmonary inflammatory cells in ventilated preterm infants: effect of surfactant treatment
S Arnon1, J Grigg, M Silverman
1Department of Paediatrics and Neonatal Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London.
Insights
Surfactant treatment in preterm infants did not alter chronic lung disease (CLD) rates but increased macrophages in bronchoalveolar lavage fluid (BALF). Persistent neutrophils in BALF by day 7 indicate CLD risk, irrespective of surfactant use.
Area of Science:
- Neonatal Medicine
- Pulmonology
- Critical Care
Background:
- Mechanically ventilated preterm infants are at high risk for chronic lung disease (CLD).
- Inflammatory cell profiles in bronchoalveolar lavage fluid (BALF) may predict CLD development.
- The impact of surfactant treatment on these inflammatory markers and CLD is not fully understood.
Purpose of the Study:
- To investigate the effect of surfactant treatment on inflammatory cell counts in BALF.
- To correlate BALF inflammatory cell distribution with the development of CLD in preterm infants.
- To examine the relationship between surfactant administration, BALF cells, and CLD outcomes.
Main Methods:
- Prospective study of 25 surfactant-treated and 29 non-treated mechanically ventilated preterm infants.
- Collection of BALF on days 1, 3, 5, and 7 post-birth.
- Cell counts and differential analysis of 300 cells per BALF sample.
Main Results:
- CLD incidence was similar between surfactant-treated and non-treated groups.
- Infants developing CLD showed higher polymorphonuclear leucocytes and lower macrophages on days 5 and 7.
- Surfactant treatment increased total white cell count on day 3 and macrophage numbers from day 3 to 7.
- Persistent neutrophilia in BALF at day 7 was associated with CLD, unaffected by surfactant.
Conclusions:
- CLD in preterm infants is linked to persistent high levels of polymorphonuclear leucocytes in BALF.
- Surfactant treatment leads to a sustained increase in BALF macrophages.
- The association between persistent neutrophilia and CLD development is independent of surfactant administration.
Abstract:
The aim of this study was to determine the effect of surfactant treatment on the number and distribution of inflammatory cells in bronchoalveolar lavage fluid (BALF) from mechanically ventilated preterm infants over the first week of life in relation to the subsequent development of chronic lung disease (CLD). The study included 25 babies who received surfactant on clinical grounds and 29 babies of similar severity who did not. BALF was collected on days 1, 3, 5, and 7 after birth. Cell counts were performed and differentials were calculated on 300 cells. CLD was equally common in both treatment groups. Of the 54 infants, 29 (53%) who developed CLD had a higher incidence of patent ductus arteriosus and air leak and needed a higher concentration of inspired oxygen on the fifth and seventh days of life. Babies who developed CLD had more polymorphonuclear leucocytes and fewer macrophages on days 5 and 7 than those who recovered. Surfactant treatment was associated with a higher total white cell count on day 3. Between days 3 and 7, macrophage numbers were higher in surfactant treated babies, whatever the pulmonary outcome. This data suggests that CLD was associated with persistence of high numbers of polymorphonuclear leucocytes in BALF at the end of the first week. Surfactant treatment caused a persistent increase in macrophage numbers. The association between persistent neutrophilia and CLD was unaffected by surfactant treatment.