ABSTRACT. We have previously shown that intravascular platelet activating factor (PAF) causes ischemic bowel necrosis in rats morphologically similar to neonatal necrotizing enterocolitis (NEC). Because endotoxin (LPS) and hypoxia are risk factors for NEC, we studied their effect on PAF metabolism and the development of intestinal injury. Young male Sprague-Dawley rats were anesthetized with pentobarbital and divided into six experimental groups: 1 ) control, 2) LPS alone (2 mglkg), 3) hypoxia alone (5% 04, 4) LPS + hypoxia, 5) WEB 2086 (PAF antagonist) + LPS + hypoxia, and 6) SRI 63-441 (PAF antagonist) + LPS + hypoxia. Evaluations included blood pressure recording, superior mesenteric artery blood flow, arterial blood gas, white blood cell count, hematocrit, plasma PAF, plasma acetylhydrolase, plasma tumor necrosis factor, intestinal perfusion, and intestinal injury at 3 h.We found that LPS + hypoxia synergistically contributed to hypotension (mean blood pressure 27 f 5.6% baseline versus 101 f 3.9% control), metabolic acidosis (pH 7.05, base deficit 24 mEq/L), hemoconcentration, decreased superior mesenteric artery blood flow (2.2 f 0.3 mL/min versus 5.8 f 0.2 mL/min control), and intestinal injury.The morbidities resulting from LPS + hypoxia were partially or completely prevented by PAF antagonists. In addition, animals treated with LPS + hypoxia had neutropenia, elevated plasma acetylhydrolase, and elevated plasma TNF. These results suggest that endogenous PAF may contribute to LPS + hypoxia-induced intestinal hypoperfusion and necrosis. (Pediatr Res 31: 428-434,1992) Abbreviations PAF, platelet activating factor LPS, lipopolysaccharide, endotoxin WBC, white blood cell count TNF, tumor necrosis factor NEC, necrotizing enterocolitis SMA, superior mesenteric artery NEC is a common gastrointestinal disease of premature infants that has a high incidence of morbidity and mortality (1). Alto the development of the disease (2, 3). We have previously shown that intravascular administration of PAF (PAF-acether), an endogenous phospholipid inflammatory mediator, produces intestinal injury in an animal model (4). In addition, it is known that endotoxin (LPS)-induced shock and intestinal injury can be prevented by PAF receptor antagonists (5, 6). Because we have recently reported increased plasma PAF concentrations in newborns afflicted with NEC (7), it is possible that, in addition to causing experimental intestinal injury, PAF is an important endogenous mediator of the human disease.Additional factors related to PAF metabolism may play a role in the development of intestinal injury. PAF is rapidly degraded to the inactive metabolite lysoPAF by acetylhydrolase (8), a 43-kD acid-labile enzyme critical to PAF regulation. We have shown that serum acetylhydrolase is decreased in NEC patients compared with controls (7) and that newborn infants have lower acetylhydrolase activity than older children and adults (9). Because the majority of NEC cases occur in the neonatal period, suppressed PAF degradation may contribut...