title: Prostaglandin E2 Mediates Cardiorespiratory Disturbances during Infection in Neonates.
abstract: OBJECTIVE
  To determine whether infection, with associated eicosanoid release, is a main cause of respiratory disruption in neonates, by measuring levels of prostaglandin E2 (PGE2) and its metabolite (PGEM) in cerebrospinal fluid (CSF).
  
  
  METHODS
  Of 59 eligible infants, 25 preterm infants (mean gestational age, 28 ± 0.5 weeks) and 22 full-term infants (mean gestational age, 40 ± 0.5 weeks) from a level 3 neonatal intensive care unit and the general maternity neonatal ward were enrolled prospectively. Infants with a condition that can cause secondary apnea were excluded. Cardiorespiratory disturbances, such as apnea, bradycardia, and desaturation (ABD) events, were quantified. All infants were subjected to standard laboratory analysis of blood and CSF concentrations of biomarkers, including PGE2 and PGEM, within 24 hours of lumbar puncture, which were correlated with ABD events and culture-verified infections.
  
  
  RESULTS
  PGEM levels were highest in infants with culture-verified sepsis and meningitis (P < .01). In infants without culture-verified bacterial infections, PGEM levels were higher in preterm infants compared with term infants (P < .05). The numbers of desaturation events and apnea events in neonates were positively associated with PGE2 levels in CSF (P < .05).
  
  
  CONCLUSIONS
  PGE2 and PGEM are rapidly elevated in CSF during an infectious event and may explain cardiorespiratory disturbances, which are the major presenting symptoms of neonatal infections. PGE2 and PGEM are released during bacterial infections and could serve as biomarkers for sepsis and autonomic dysfunction in neonates.
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Veronica
authors.initials: V
authors.lastname: Siljehav
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Annika M
authors.initials: AM
authors.lastname: Hofstetter
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Kristin
authors.initials: K
authors.lastname: Leifsdottir
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. Electronic address: Eric.Herlenius@ki.se.
authors.forename: Eric
authors.initials: E
authors.lastname: Herlenius
mesh_terms: D001049:Apnea / Q000209:etiology / Q000378:metabolism*; D001424:Bacterial Infections / Q000150:complications / Q000378:metabolism*; D015415:Biomarkers / Q000097:blood / Q000134:cerebrospinal fluid; D001919:Bradycardia / Q000209:etiology / Q000378:metabolism*; D015232:Dinoprostone / Q000097:blood / Q000134:cerebrospinal fluid* / Q000378:metabolism; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D015232:Dinoprostone