Secretory phospholipase A₂ pathway during pediatric acute respiratory distress syndrome: a preliminary study.
OBJECTIVE
To verify if secretory phospholipase A2 (sPLA2) is increased in pediatric acute respiratory distress syndrome (ARDS) triggered or not by respiratory syncytial virus infection and to clarify how the enzyme may influence the disease severity and the degree of ventilatory support.


METHODS
Prospective pilot study.


METHODS
Two academic pediatric intensive care units.


METHODS
All infants < 6 months old hospitalized for severe respiratory syncytial virus bronchiolitis, who developed ARDS (respiratory syncytial virus-ARDS group); all infants < 6 months old diagnosed with ARDS secondary to other causes (ARDS group); and infants < 6 months old who needed ventilation for reasons other than any lung disease (control group).


METHODS
None.


RESULTS
We enrolled six respiratory syncytial virus -ARDS babies, five ARDS babies, and six control infants. The sPLA2 activity and tumor necrosis factor (TNF)-α were significantly higher in the bronchoalveolar lavage of ARDS infants. Worst oxygenation, ventilation, and longer pediatric intensive care unit stay and ventilation time were present in ARDS babies. No differences were found in Clara cell secretory protein and in serum cytokines levels. Because there is no correlation between bronchoalveolar lavage protein content (a marker of permeability) and sPLA2, the enzyme seems mainly produced in the alveoli. TNF-α, the main inductor of sPLA2 expression, significantly correlates with the enzyme level in the bronchoalveolar lavage. Significant positive correlations exist between sPLA2, TNF-α and oxygen need, mean airway pressure, ventilatory index, and the Murray's lung injury score. Negative correlations were also found between sPLA2, TNF-α, and Pao2/Fio2 ratio.


CONCLUSIONS
The sPLA2 and TNF-α are increased in ARDS and seem correlated with clinical severity, higher oxygen requirement, and more aggressive ventilation. This correlation confirms findings from adult experience and should guide further investigations on pediatric ARDS pathophysiology.
De Luca
Daniele
D
Neonatal Intensive Care Unit, Institute of Mother And Child Sciences, Women's and Children Hospital G. Salesi, Polytechnical University of Marche, Ancona, Italy. dm.deluca@fastwebnet.it
Minucci
Angelo
A
Cogo
Paola
P
Capoluongo
Ettore D
ED
Conti
Giorgio
G
Pietrini
Domenico
D
Carnielli
Virgilio P
VP
Piastra
Marco
M
D018893:Bronchoalveolar Lavage; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007558:Italy; D008297:Male; D054497:Phospholipases A2, Secretory / Q000378:metabolism*; D010865:Pilot Projects; D011446:Prospective Studies; D012128:Respiratory Distress Syndrome / Q000378:metabolism* / Q000821:virology*; D018357:Respiratory Syncytial Virus Infections / Q000150:complications* / Q000378:metabolism*; D014409:Tumor Necrosis Factor-alpha / Q000378:metabolism
D014409:Tumor Necrosis Factor-alpha; D054497:Phospholipases A2, Secretory