Introduction Mechanical ventilation (MV) induces expression of pro-inflammatory cytokines. Early nasal continuous positive airway pressure (nCPAP) seems to prevent ventilator-induced lung injury – and these effects have not been studied in humans.
Objective To evaluate plasma levels IL-1β, IL-6, IL-8, IL-10, and TNF-α immediately before the start of nCPAP and 2h later.
Methods Prospective cohort including preterm newborns with gestational age of 28–35 weeks admitted to a NICU for respiratory support. Newborns with malformations, congenital infections, sepsis, surfactant treatment, and receiving ventilatory support in the delivery room were excluded. Blood samples were collected right before and 2 h after the start of ventilation. Wilcoxon test was used for comparisons.
Results 23 preterm (mean weight 1850.65 ± 403g; GA 32,36 ± 1,74 weeks) were treated with nCPAP. A significant decrease in IL-6 levels was observed after 2 h of nCPAP. Of 15 newborns whose mothers received antenatal steroid, cytokine level was lower at the onset of nCPAP in all patients compared to those whose mothers didn’t receive the treatment, but this effect was not sustained after 2 h.
Conclusion nCPAP was associated with minimal release of pro-inflammatory cytokines and seems to play a less harmful role, which was enhanced by the use of antenatal steroids. As MV usually promotes a significant inflammatory response, the use of nCPAP as initial protective respiratory strategy for preterm with moderate respiratory distress should be supported.
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