Abstract
Neonates failing conventional ventilation were treated with a combined High Frequency Oscillatory(HFO)-Intermittend Mandatory(IMV) system for rescue. Analysis of sequential pulmonary effluents during HFO-IMV was performed in seven of these infants. Gestational age ranged from 28-39 weeks, weight from 800-3000g. There was no difference between the primary pulmonary diagnoses and complications of survivors (4) and non-survivors (3). Due to the small number of collections prior to their demise, interpretation of analyses of effluents in the non-survivors is difficult. Effluents of the survivors had high concentrations of human neutrophil elastase(HNE)(range 0.013-1.712 ug/ml) and a1-antiproteinase(a1-AP) (range 28.5-294.5 ug/ml), peaking at days 3 to 5 of treatment. The inverse pattern was seen for the a1-proteinase inhibitor activity (a1-PI), which decreased by 50-100% in the effluents of three of the survivors. Compared to conventionally ventilated control infants, infants with RDS or RDS/bronchopulmonary dysplasia(BPD) the HFO-IMV infants had 8.8 fold higher mean albumin concentrations and markedly lower HNE/albumin and a1-PI/albumin ratios. High HNE/albumin and reduced a1-PI/albumin ratios contribute to lung injury and may facilitate the development of chronic lung disease. None of these HFO-IMV survivors had BPD. In view of the small number of cases and the high albumin levels, the significance of the low HNE/albumin and a1-PI/albumin ratios in the effluent of the HFO-IMV infants warrants further investigation.
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Blum-Hoffmann, E., Hoffmann, G., Merritt, T. et al. 8 HUMAN NEUTROPHIL ELASTASE AND a -PROTEINASE IMBALANCE IN PULMONARY EFFLUENTS IN INFANTS RESCUED WITH HIGH FREQUENCY OSCILLATORY VENTILATION. Pediatr Res 20, 1035 (1986). https://doi.org/10.1203/00006450-198610000-00062
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DOI: https://doi.org/10.1203/00006450-198610000-00062