Objectives

To evaluate the impact of invasive mechanical ventilation associated with two serum inflammatory cytokines and clinical indicators, on the second day of life, as predictors of bronchopulmonary dysplasia in very low birth weight preterm infants. It was hypothesized that the use of invasive mechanical ventilation in the first hours of life is associated with biomarkers that may predict the chances of preterm infants to develop bronchopulmonary dysplasia.

Methods

Prospective cohort of 40 preterm infants with gestational age <34 weeks and birth weight <1500 g. The following were analyzed: clinical variables; types of ventilator support used (there is a higher occurrence of bronchopulmonary dysplasia when oxygen supplementation is performed by long periods of invasive mechanical ventilation); hospitalization time; quantification of two cytokines (granulocyte and macrophage colony stimulating factor [GM-CSF] and eotaxin) in blood between 36 and 48 h of life. The preterm infants were divided in two groups: with and without bronchopulmonary dysplasia.

Results

The GM-CSF levels presented a significantly higher value in the bronchopulmonary dysplasia group (p = 0.002), while eotaxin presented higher levels in the group without bronchopulmonary dysplasia (p = 0.02). The use of continuous invasive mechanical ventilation was associated with increased ratios between GM-CSF and eotaxin (100% sensitivity and 80% specificity; receiver operating characteristic area = 0.9013, CI = 0.7791–1.024, p < 0.0001).

Conclusions

The duration of invasive mechanical ventilation performed in the first 48 h of life in the very low birth weight infants is a significant clinical predictor of bronchopulmonary dysplasia. The use of continuous invasive mechanical ventilation was associated with increased ratios between GM-CSF and eotaxin, suggesting increased lung injury and consequent progression of the disease.

中文翻译：

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有创机械通气和生物标志物作为早产儿支气管肺发育不良的预测因子

目标

评估与两种血清炎性细胞因子和临床指标相关的有创机械通气在出生后第二天作为极低出生体重早产儿支气管肺发育不良预测因子的影响。据推测，在生命的最初几个小时内使用有创机械通气与可以预测早产儿发生支气管肺发育不良的机会的生物标志物有关。

方法

40 名胎龄 <34 周且出生体重 <1500 g 的早产儿的前瞻性队列。分析了以下内容：临床变量；使用的呼吸机支持类型（当通过长时间有创机械通气进行氧气补充时，支气管肺发育不良的发生率更高）；住院时间；生命 36 至 48 小时血液中两种细胞因子（粒细胞和巨噬细胞集落刺激因子 [GM-CSF] 和嗜酸性粒细胞趋化因子）的定量。早产儿分为两组：有和没有支气管肺发育不良。

结果

GM-CSF 水平在支气管肺发育不良组中表现出显着更高的值（p = 0.002），而在无支气管肺发育不良组中 eotaxin 表现出更高水平（p = 0.02）。使用持续有创机械通气与 GM-CSF 和 eotaxin 之间的比率增加相关（100% 敏感性和 80% 特异性；接受者操作特征面积 = 0.9013，CI = 0.7791-1.024，p < 0.0001）。

结论

极低出生体重婴儿在出生后 48 小时内进行有创机械通气的持续时间是支气管肺发育不良的重要临床预测指标。持续有创机械通气的使用与 GM-CSF 和 eotaxin 之间的比率增加有关，这表明肺损伤增加和随后的疾病进展。