Transient Defect in Nitric Oxide Generation after Rupture of Fetal Membranes and Responsiveness to Inhaled Nitric Oxide in Very Preterm Infants with Hypoxic Respiratory Failure

摘要: Objective To study antenatal risk factors and inflammatory responses during hypoxic respiratory failure (HRF) in infants of very low gestational age (VLGA, ≤32.0 weeks). Study design Of a cohort 765 VLGA infants, 144 required mechanical ventilation. Airway specimens from these patients were prospectively studied. Infants who developed HRF (oxygenation index >25) with echocardiographic diagnosis pulmonary hypertension treated inhaled nitric oxide (iNO). Three gestation comparison groups formed on the basis specific complications: prolonged preterm rupture membranes (PPROM), spontaneous birth, preeclampsia. Chest radiographs studied airway analyzed for concentrations tumor necrosis factor-α, interleukin (IL)-6, IL-8, IL-10, IL-12p70, IL-1β, nitrite + nitrate over 4 days. Results Seventeen (2.2% all infants) HRF. In 17 cases, PPROM complicated course; responded to iNO, regardless infection or PPROM. The chest non-HRF similar. proinflammatory cytokines levels HRF, but they increased iNO treatment remained elevated after discontinuation iNO. Each 3 had different characteristic patterns levels. Conclusions Seven percent 15% those characterized by that acutely responds These may have transient deficiency response, including defect generation airspaces.