Comparison of serum levels of seven cytokines in premature newborns undergoing different ventilatory procedures: high frequency oscillatory ventilation or synchronized intermittent mandatory ventilation.
OBJECTIVE
The severity of pulmonary dysfunction and subsequent development of chronic lung disease (CLD) in preterm neonates depends on several factors, among them oxygen administration. The aim of this report is to compare the effects of high-frequency, oscillatory ventilation (HFOV) versus synchronized, intermittent, mandatory ventilation (sIMV) on serum cytokine levels (IL-6, IL-8, IL-10, MCP-1, PDGF-BB, VEGF and TGF-beta1) and ventilator indices during the first week of life. Moreover, CLD development and several other outcomes were compared between the two groups.


METHODS
Randomized clinical trial.


METHODS
Third level NICU.


METHODS
40 preterm neonates with a gestational age between 24 and 29 weeks were randomly (20 per group) assigned to one of the two, above-mentioned ventilation strategies within 30 minutes of birth.


RESULTS
At 1, 3 and 5 days, neonates were monitored by means of ventilator indices and levels of seven pro-inflammatory or anti-inflammatory (pro-fibrotic) cytokines in serum. No clinical or biochemical differences were observed at baseline. The neonates assigned to HFOV benefited from early and sustained improvement in gas exchange, with earlier extubation and lower incidence of CLD, as compared to the neonates assigned to sIMV treatment, and showed a significant reduction of serum IL-6, IL-8 and IL-10 over time only when the HFOV treatment was administered. In addition, at days 3 and 5, the IL-6 levels were significantly lower in the HFOV group as compared to sIMV patients.


CONCLUSIONS
The results of this randomized clinical trial support the hypothesis that early use of HFOV, combined with an optimum volume strategy, has a beneficial effect, reducing serum levels of pro-inflammatory cytokines and consequently the acute phase leading to lung injury.
Capoluongo
Ettore
E
Laboratory of Clinical Molecular Biology, Department of Biochemistry & Clinical Biochemistry-Catholic University of the Sacred Heart, Largo F. Vito 1, 00168 Rome, Italy. ecapoluongo@rm.unicatt.it
Vento
Giovanni
G
Santonocito
Concetta
C
Matassa
Piero Giuseppe
PG
Vaccarella
Cinzia
C
Giardina
Bruno
B
Romagnoli
Costantino
C
Zuppi
Cecilia
C
Ameglio
Franco
F
D002908:Chronic Disease; D016207:Cytokines / Q000097:blood*; D006612:High-Frequency Ventilation; D006801:Humans; D015994:Incidence; D007223:Infant; D007385:Intermittent Positive-Pressure Ventilation; D008171:Lung Diseases / Q000453:epidemiology / Q000517:prevention & control*
D016207:Cytokines