Early Activation of Inflammation and Clotting in the Preterm Lamb with Neonatal RDS: Comparison of Conventional Ventilation and High Frequency Oscillatory Ventilation

Jaarsma, AS; Braaksma, Margriethe A; Geven, W.B.; Oeveren, Wim van; Oetomo, Sidarto Bambang

doi:10.1203/00006450-200111000-00019

Cited by 18 publications

(12 citation statements)

References 28 publications

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“…In a previous study, we found systemic activation of the inflammatory reaction at 15 min after birth in ventilated preterm lambs with RDS [5]. In this study, we demonstrated that systemic activation of the inflammatory reaction takes place within 5 min after preterm birth, since the number of PMNs decreased and ß-glucuronidase levels increased significantly within 5-10 min after birth in ventilated preterm lambs with RDS.…”

Section: Discussionsupporting

confidence: 62%

“…In a previous study, we found systemic activation of the inflammatory reaction at 15 min after birth in ventilated preterm lambs with RDS [5]. However, the first blood sample in that study was taken 15 min after delivery; therefore, it was unknown whether the inflammatory reaction was activated due to ventilation or due to delivery or already existed before delivery.…”

Section: Introductionmentioning

confidence: 91%

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Activation of the Inflammatory Reaction within Minutes after Birth in Ventilated Preterm Lambs with Neonatal Respiratory Distress Syndrome

Jaarsma

Geven²,

Oeveren³

et al. 2004

Neonatology

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To study the activation of the inflammatory reaction within minutes after birth, we measured parameters of inflammation before and immediately after birth. To assess whether respiratory distress syndrome (RDS) or birth itself initiates activation, we compared preterm ventilated lambs with term nonventilated lambs. Preterm lambs were delivered by cesarean section at 132 days gestational age (term 145 days) and were ventilated by conventional ventilation (n = 9). Before clamping the cord, 5, 10 and 15 min after birth, blood was sampled from umbilical catheters. Term lambs (n = 9) were born spontaneously after 140–145 days gestational age. Immediately after birth, a venous umbilical catheter was inserted. Blood was sampled before the first breath and 5, 10, 15 and 20 min after birth while the lamb was breathing spontaneously. Blood was analyzed for AP50 (complement activation), number of polymorphonuclear leukocytes (PMNs) and β-glucuronidase (released from activated PMNs). In preterm lambs, we found a decreased number of PMNs and increased levels of β-glucuronidase already at 5 min after birth. In the term lambs, we found only a short-term mild decrease in PMNs and short-term increase in β-glucuronidase. We conclude that systemic activation of the inflammatory reaction can be found in ventilated preterm lambs with RDS within 5 min after birth. This very early activation is mild, transient and less pronounced in term-born spontaneously breathing lambs compared with preterm, ventilated lambs with RDS.

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Section: Discussionsupporting

confidence: 62%

Section: Introductionmentioning

confidence: 91%

Activation of the Inflammatory Reaction within Minutes after Birth in Ventilated Preterm Lambs with Neonatal Respiratory Distress Syndrome

Jaarsma

Geven²,

Oeveren³

et al. 2004

Neonatology

Self Cite

View full text Add to dashboard Cite

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“…29 In this regard, theoretically 'less injurious for the immature lung' HFOV could be associated with reduced release of several inflammatory mediators in the blood of neonates requiring artificial ventilation. Indeed, Jaarsma et al 30 reported attenuated systemic activation of inflammation in preterm lambs with RDS ventilated with HFOV relative to conventional ventilation. In addition, Capoluongo et al 7 found significantly lower circulating levels of IL-6 on days 3 and 5 of life, when an optimal HFOV strategy was applied as compared with SIMV for the management RDS in preterm neonates.…”

Section: Discussionmentioning

confidence: 99%

Comparable effect of conventional ventilation versus early high-frequency oscillation on serum CC16 and IL-6 levels in preterm neonates

et al. 2010

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Objective: Clara cell 16 kD protein (CC16) and interleukin (IL)-6 have been used as peripheral blood biomarkers of alveolar leakage and inflammation, respectively. Thus, their measurement in the bloodstream could be used to assess ventilator-induced lung injury. The objective of this study was to evaluate the effect of optimized synchronized intermittent mandatory ventilation (SIMV) and high-frequency oscillatory ventilation (HFOV) on circulating CC16 and IL-6 levels when used as the initial ventilation modes in preterm neonates.Study Design: Single center, prospective, randomized clinical study in preterm neonates (gestational age p30 weeks) requiring mechanical ventilation within the first 2 h of life. Serum CC16 and IL-6 were measured on establishment of the assigned ventilation mode after admission, at days 3 and 14 of life as well as at 36 weeks postmenstrual age. Demographicperinatal data and clinical parameters were also recorded.Result: Of the 30 neonates studied, 24 (gestational age 27.1 ± 1.7 weeks, birth weight 942±214 g) were finally analyzed, equally assigned into the SIMV and HFOV groups. Both groups had comparable demographicperinatal characteristics and clinical parameters. Serum CC16 and IL-6 altered significantly over time (repeated-measures analysis of variance, both P<0.001). However, changes were not affected by the ventilation mode. Post hoc analysis showed a significant decrease in CC16 and IL-6 from birth up to 36 weeks postmenstrual age in both groups. Conclusion:In preterm neonates, SIMV and HFOV are associated with comparable circulating CC16 and IL-6 levels. These findings suggest a similar alveolar leakage and systemic inflammation with any of the ventilation modes evaluated when their usage is optimized.

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“…This is a life-threatening, rapidly progressing fibrotic disorder in infants that occurs as a complication of neonatal respiratory distress syndrome (RDS) (19). BPD is thought to be the result of an excessive inflammatory response (20), and earlier studies have established the significance of neutrophils in the alveolar microenvironment in this process (21,22). Furthermore, the levels of several mediators, such as IL-6 (23-25), IL-8 (23,25), TNF-a (25), and endothelin-1 (ET-1) (26), have been found to be increased in tracheal aspirates from infants with BPD.…”

mentioning

confidence: 99%

Endothelin-1 Signaling Promotes Fibrosis In Vitro in a Bronchopulmonary Dysplasia Model by Activating the Extrinsic Coagulation Cascade

Kambas

Chrysanthopoulou

Kourtzelis

et al. 2011

The Journal of Immunology

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Neonatal respiratory distress syndrome can progress to bronchopulmonary dysplasia (BPD), a serious pulmonary fibrotic disorder. Given the involvement of the extrinsic coagulation cascade in animal models of lung fibrosis, we examined its role in BPD. We observed a higher number of neutrophils expressing tissue factor (TF) in bronchoalveolar lavage fluid (BALF) from infants with BPD than from those with uncomplicated respiratory distress syndrome together with a parallel decrease in TF and connective tissue growth factor (CTGF) in BALF supernatants during the disease course. The involvement of coagulation in the fibrotic process associated with BPD was further evaluated by treating primary human colonic myofibroblasts with BALF supernatants from infants with BPD. These human colonic myofibroblasts demonstrated an enhanced C5a- and thrombin-dependent migration. Moreover, they expressed TF in an endothelin-1–dependent manner, with subsequent activation of the extrinsic coagulation cascade and CTGF production mediated by protease-activator receptor-1 signaling. These data provide a novel mechanism for the development of BPD and indicate that endothelin-1 signaling contributes to fibrosis by upregulating a TF/thrombin amplification loop responsible for CTGF production, and offer novel and specific therapeutic targets for pulmonary fibrotic disease.

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Early Activation of Inflammation and Clotting in the Preterm Lamb with Neonatal RDS: Comparison of Conventional Ventilation and High Frequency Oscillatory Ventilation

Cited by 18 publications

References 28 publications

Activation of the Inflammatory Reaction within Minutes after Birth in Ventilated Preterm Lambs with Neonatal Respiratory Distress Syndrome

Activation of the Inflammatory Reaction within Minutes after Birth in Ventilated Preterm Lambs with Neonatal Respiratory Distress Syndrome

Comparable effect of conventional ventilation versus early high-frequency oscillation on serum CC16 and IL-6 levels in preterm neonates

Endothelin-1 Signaling Promotes Fibrosis In Vitro in a Bronchopulmonary Dysplasia Model by Activating the Extrinsic Coagulation Cascade

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