Systemic markers of inflammation in preterm very low birth weight infants depending on the method of secondary non-invasive respiratory support
Development of inflammatory reactions (biotrauma) is the primary mechanism of lung injury during mechanical ventilation. Cytokines play a key role in this process. This open randomized study looked at the influence of different methods of respiratory support on IL-6 and IL-8 serum levels in very preterm infants. The study included 47 very preterm infants (gestation age ≤ 32 weeks) with respiratory distress syndrome (RDS) who were treated with mechanical ventilation (MV). Within the first three days of life, before extubation infants were randomized into two groups: non-invasive ventilation (NV) (n = 19) and continuous positive airway pressure (СРАР) (n = 18). The third group included 10 infants ventilated longer than three days (comparison group).The levels of interleukins in blood serum were measured by ELISA on the 3rdand on the 14th day of life. Mortality, incidences of bronchopulmonary dysplasia (BPD), as well as duration of MV, noninvasive respiratory support (NRS), and oxygen therapy were compared in the groups. No differences were observed between the NV and CPAP groups in the duration of MV and NRS. Infants from the comparison group needed longer MV with higher ventilation settings. There were no statistically significant differences between the levels of IL-6 and IL-8 in the groups on the 3rdand on the 14th day of life. However, statistically significant reduction of IL-6 concentrations was observed in the NV group on the 14thday of life compared to the initial ones (Р < 0.01). Longer duration of MV (rS = 0.3; P < 0.05), death (rS = 0.3; P < 0.05), BPD or death (rS = 0.34; P < 0.05) were associated with higher IL-6 levels on the 3rdday of life. Longer duration of NRS support (rS = 0.5; P < 0.05), longer neonatal intensive care unit stay (rS = 0.44; P < 0.05), BPD or death (rS = 0.33; P < 0.05), and moderate BPD (rS = 0.35; P < 0.05) were associated with higher IL-6 levels on the 14thday of life. Levels of IL-8 assessed on the third and 14th days of life did not correlate with duration of respiratory support, incidence of BPD or mortality. Non-invasive ventilation is associated with statistically significant reduction of serum IL-6 levels in preterm infants as opposed to CPAP. Moderate BPD was associated with higher IL-6 levels on the 14th day of life. Therefore non-invasive ventilation may be consider a safer respiratory support method in comparison with CPAP.
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