Abstract
Background: Neonatal sepsis is a disease with a high impact on endothelium dysfunction, resulting in an impairment of microcirculation. The first clinical signs may be feeding intolerance and a prominent abdomen with palpable bowl, suggesting that the intestinal microcirculation is a location, where early endothelium response of the neonatal organism can be observed. As of today evaluation of the neonatal microcirculation ist still a challenge, intravital microscopy (Orthogonal Polarization Spectral-Imaging) seems to be a promising new approach. Protein C, the zymogen of vitamin K dependent serine protease activated Protein C plays a pivotal role in regulation of microvascular coagulation and inflammation. Mortality in septic patients can be decreased by the use of Protein C. However, the direct impact of Protein C on the microvascular blood flow has not been investigated, yet.
Methods: Endotoxin shock was induced in 10 piglets under general anesthesia by intravenous application of 500 ìg/kgE. coli lipopolysaccarids. 5 piglets received human Protein C concentrate (Ceprotin®,Fa. Baxter) with an initial bolus of 50 ìg/kg followed by continuous infusion of 200 ìg/kg/d. 5 piglets served as control group. Monitoring of hemodynamic and coagulation parameters, WBC,Hct and PLT was performed. After laparotomy, intestinal microcirculation was assessed by Cytoscan Intravital Microscopy in a defined time schedule (prae,30,60,90,120,150,180 min after LPS-exposure).
Results: Early impairment of the microcirculation was observed 1 h after LPS-exposure, when macroscopic evaluation of the gut and clincial hemodynamic parameters were still normal. Obvious reduction of microvascular bloodflow (reduction of capillary density, capillary red blood cell velocity) was observed in the control group, whereas microvascular impairment in the PC-group was attenuated and capillary blood flow could be maintained. Microvascular impairment was accompanied by a decrease of platelets and leukocytes with less decrease in the PC-Group compared to the control group (all values in mean).
Conclusion: Early impairment of microcirculation of septic organisms can be observed via OPS-Imaging, when macroscopic examination and standart hemodynamic monitoring remain unchanged. In this small collective, human Protein C seems to attenuate microvascular impairment in septic organisms.
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Fischer, D., Nold, M. & Veldman, A. 85 Intestinal Microcirculation in Neonatal Piglets with Lps-Induced Septic Shock: Influence of Human Protein C Concentrate (Ceprotin®). Pediatr Res 56, 478 (2004). https://doi.org/10.1203/00006450-200409000-00108
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DOI: https://doi.org/10.1203/00006450-200409000-00108