title: Sphingolipids in Congenital Diaphragmatic Hernia; Results from an International Multicenter Study.
abstract: Congenital diaphragmatic hernia is a severe congenital anomaly with significant mortality and morbidity, for instance chronic lung disease. Sphingolipids have shown to be involved in lung injury, but their role in the pathophysiology of chronic lung disease has not been explored. We hypothesized that sphingolipid profiles in tracheal aspirates could play a role in predicting the mortality/ development of chronic lung disease in congenital diaphragmatic hernia patients. Furthermore, we hypothesized that sphingolipid profiles differ between ventilation modes; conventional mechanical ventilation versus high-frequency oscillation.
  
  
  
  Sphingolipid levels in tracheal aspirates were determined at days 1, 3, 7 and 14 in 72 neonates with congenital diaphragmatic hernia, born after > 34 weeks gestation at four high-volume congenital diaphragmatic hernia centers. Data were collected within a multicenter trial of initial ventilation strategy (NTR 1310).
  
  
  
  36 patients (50.0%) died or developed chronic lung disease, 34 patients (47.2%) by stratification were initially ventilated by conventional mechanical ventilation and 38 patients (52.8%) by high-frequency oscillation. Multivariable logistic regression analysis with correction for side of the defect, liver position and observed-to-expected lung-to-head ratio, showed that none of the changes in sphingolipid levels were significantly associated with mortality /development of chronic lung disease. At day 14, long-chain ceramides 18:1 and 24:0 were significantly elevated in patients initially ventilated by conventional mechanical ventilation compared to high-frequency oscillation.
  
  
  
  We could not detect significant differences in temporal sphingolipid levels in congenital diaphragmatic hernia infants with mortality/development of chronic lung disease versus survivors without development of CLD. Elevated levels of ceramides 18:1 and 24:0 in the conventional mechanical ventilation group when compared to high-frequency oscillation could probably be explained by high peak inspiratory pressures and remodeling of the alveolar membrane.
authors.affiliation: Intensive Care and Department of Paediatric Surgery, Erasmus Medical Center- Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Kitty G
authors.initials: KG
authors.lastname: Snoek
authors.affiliation: Department of Neonatology, Erasmus Medical Center- Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Irwin K M
authors.initials: IK
authors.lastname: Reiss
authors.affiliation: Intensive Care and Department of Paediatric Surgery, Erasmus Medical Center- Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Tibboel
authors.affiliation: Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: van Rosmalen
authors.affiliation: Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, Rome, Italy.
authors.forename: Irma
authors.initials: I
authors.lastname: Capolupo
authors.affiliation: Department of Neonatology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Arno
authors.initials: A
authors.lastname: van Heijst
authors.affiliation: Department of Neonatology, Universitätsklinikum Mannheim, Mannheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schaible
authors.affiliation: Program of Physiology and Experimental Medicine, Hospital for Sick Children Research Institute, Toronto, Canada.
authors.forename: Martin
authors.initials: M
authors.lastname: Post
authors.affiliation: Intensive Care and Department of Paediatric Surgery, Erasmus Medical Center- Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Tibboel
mesh_terms: D005260:Female; D065630:Hernias, Diaphragmatic, Congenital / Q000378:metabolism*; D006801:Humans; D007231:Infant, Newborn; D038622:Internationality; D008297:Male; D013107:Sphingolipids / Q000378:metabolism*
chemical_list: D013107:Sphingolipids