Background
Preterm infants often receive mechanical ventilation and oxygen at birth. Exposure to large tidal volumes (VT) at birth causes lung inflammation and oxygen may amplify the injury. We hypothesized that normal VT ventilation at birth causes lung injury that is exacerbated by 95% oxygen.
Methods
The head and chest of anesthetized preterm fetal sheep (129±1d gestation) were surgically exteriorized while maintaining the placental circulation. Fetuses were randomized to four groups with either: 1) VT ventilation to 6 mL/kg or 2) CPAP of 5 cm H2O, and either: a) 95%O2/5%CO2 or b) 95%N2/5%CO2. Age-matched fetuses were controls. After a 15-minute intervention, the fetal lamb was returned to the uterus for 1 h 45 min.
Results
In ventilated lambs, VT was 6.2±0.4 mL/kg at 15 min. Ventilation increased pro-inflammatory cytokines compared to control and CPAP only lambs, with recruitment of primarily monocytes to bronchioalveolar lavage fluid. Early response protein 1 was activated around the bronchioles in VT ventilated animals. The 15-min oxygen exposure did not change inflammatory mediators or other markers of lung and oxidative stress.
Conclusions
A VT of 6–7 mL/kg at birth increased early markers of injury and lung inflammation. Brief exposure to 95% oxygen did not alter lung inflammation.