Bronchoalveolar oxyradical inflammatory elements herald bronchopulmonary dysplasia.
OBJECTIVE
To quantify oxyradical inflammatory markers in serial endotracheal tube aspirates obtained from premature neonates at risk for developing bronchopulmonary dysplasia, and to correlate these parameters with clinical manifestations of the disease.


METHODS
Prospective cohort study.


METHODS
Tertiary neonatal intensive care unit.


METHODS
Twenty-eight intubated, premature infants, with 15 infants displaying simple respiratory distress syndrome and 13 infants eventually developing bronchopulmonary dysplasia.


METHODS
Endotracheal tube aspirates were collected and clinical severity scores were calculated longitudinally from an inception cohort during the first week of life. Diagnosis of bronchopulmonary dysplasia by standard criteria was recorded at 30 days of life. Various biochemical analyses related to pulmonary oxyradical stress were determined on endotracheal tube aspirates and were normalized according to the magnitude of serum/aspirate urea ratios. The demographic, illness severity, and biochemical characteristics of infants with simple respiratory distress syndrome and those characteristics of infants developing bronchopulmonary dysplasia were evaluated by masked comparison.


RESULTS
Populations of respiratory distress syndrome and bronchopulmonary dysplasia infants could be differentiated during the first week of life by means of the following parameters: gestational age; birth weight; Score of Neonatal Acute Physiology; Neonatal Therapeutic Intervention Scoring System; epithelial lining fluid leukocytes; elastase; myeloperoxidase; xanthine oxidase and catalase enzyme activities; and total sulfhydryls.


CONCLUSIONS
Infants with simple respiratory distress syndrome could be segregated from those infants who developed bronchopulmonary dysplasia by the magnitude of the epithelial lining fluid oxyradical inflammation markers. While infants developing bronchopulmonary dysplasia typically exhibited increased concentrations of these markers during the first week of life, those infants with simple respiratory distress syndrome displayed low, uniform, or decreasing values of these markers over this interval. Infants developing bronchopulmonary dysplasia demonstrate an early pulmonary inflammatory response, and one key aspect of this response involves various oxyradical-generating systems.
Contreras
M
M
Division of Critical Care Medicine, Children's Hospital, University of Wisconsin, Madison 53792-4108, USA.
Hariharan
N
N
Lewandoski
J R
JR
Ciesielski
W
W
Koscik
R
R
Zimmerman
J J
JJ
D001980:Bronchi / Q000378:metabolism* / Q000473:pathology; D001997:Bronchopulmonary Dysplasia / Q000175:diagnosis / Q000378:metabolism* / Q000473:pathology; D002374:Catalase / Q000378:metabolism; D015331:Cohort Studies; D004848:Epithelium / Q000378:metabolism / Q000473:pathology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D018836:Inflammation Mediators / Q000378:metabolism*; D019272:Leukocyte Elastase; D007962:Leukocytes / Q000473:pathology; D008297:Male; D010196:Pancreatic Elastase / Q000378:metabolism; D009195:Peroxidase / Q000378:metabolism; D011506:Proteins / Q000032:analysis; D011650:Pulmonary Alveoli / Q000378:metabolism*; D017382:Reactive Oxygen Species / Q000378:metabolism*; D012127:Respiratory Distress Syndrome, Newborn / Q000378:metabolism; D012307:Risk Factors; D013396:Suction; D013438:Sulfhydryl Compounds / Q000378:metabolism; D014969:Xanthine Oxidase / Q000378:metabolism; D000515:alpha 1-Antitrypsin / Q000378:metabolism
D018836:Inflammation Mediators; D011506:Proteins; D017382:Reactive Oxygen Species; D013438:Sulfhydryl Compounds; D000515:alpha 1-Antitrypsin; C037741:alpha 1-antitrypsin-leukocyte elastase complex; D002374:Catalase; D009195:Peroxidase; D014969:Xanthine Oxidase; D010196:Pancreatic Elastase; D019272:Leukocyte Elastase