Impact of chorioamnionitis on exhaled nitric oxide and endotracheal aspirate levels of nitrites–nitrates and interleukin‐8 in mechanically ventilated preterm neonates

Abstract

ObjectivesTo assess the influence of maternal chorioamnionitis on early exhaled nitric oxide (NO) and levels of nitrites–nitrates and interleukin (IL)‐8 in endotracheal aspirate fluid in mechanically ventilated preterm neonates.Study DesignCross‐sectional study.Patient–Subject SelectionBetween September 2007 and August 2009, 54 mechanically ventilated preterm neonates were included. Patients were divided into two groups according to the presence or absence of maternal chorioamnionitis, and those without chorioamnionitis (controls) were further stratified into two subgroups by birth weight < or ≥2,000 g.MethodologyThe ventilator used was a Babylog 8000. The NO level assessed was the plateau value given by the software of the Sievers NOA apparatus. Collection of endotracheal aspirate fluid samples was performed coinciding with routine aspirations and using the dry technique.ResultsThe two groups of control neonates showed statistically significant differences in exhaled NO expressed as nl/min and normalized exhaled NO expressed as either nl/min or nl/min/kg, so they are not homogeneous and cannot be used in clinical practice. Serum C‐reactive protein and endotracheal aspirate levels of nitrites–nitrates were significantly higher in the chorioamnionitis group than in controls (3.6 vs. 1.07 µmol/L; P = 0.035). Nitrites–nitrates levels were positively correlated with exhaled NO in ppb (ρ = 0.367; P = 0.006). Minute exhaled endogenous NO was significantly higher in the chorioamnionitis group (0.48 vs. 0.27 nl/min/kg; P = 0.021).ConclusionsIn mechanically ventilated preterm infants weighing <2,000 g, maternal chorioamnionitis was associated with an increase of early exhaled NO (nl/min/kg) and serum levels of C‐reactive protein and levels of nitrites–nitrates in endotracheal aspirate fluid. Pediatr. Pulmonol. 2011; 46:595–603. © 2011 Wiley‐Liss, Inc.

Exhaled nitric oxide in premature and mature infants during the first months of life

“…Sedated, intubated, or awake with spontaneous breathing: Infants and newborns, especially premature infants, have an irregular breathing pattern easily affected by external impacts. Therefore, many lung function and FeNO studies have been performed on sedated and intubated infants [17]. However, intubation seems to affect the levels of FeNO, and the clinical relevance of testing lung function in a sedated state is doubtful [17].…”

“…Therefore, many lung function and FeNO studies have been performed on sedated and intubated infants [17]. However, intubation seems to affect the levels of FeNO, and the clinical relevance of testing lung function in a sedated state is doubtful [17].…”

The influence of chorioamnionitis on respiratory drive and spontaneous breathing of premature infants at birth: a narrative review

“…Observational studies report that premature infants affected by any type of chorioamnionitis require resuscitation more often and more extensively at birth (Table 1) [9,[16][17][18][19][20][21][22][23][24][25][26][27]. The increased requirement of resuscitation consisted of associations between chorioamnionitis and any resuscitation/ventilatory support in four studies [17,20,21,23]; oxygen supplementation in two studies [9,23]; and intubation, cardiopulmonary resuscitation or volume expansion in six studies [16,18,19,21,24,26,27]. Pietrasanta et al observed that only a foetal inflammatory response (i.e.…”

Tidal breath eNO measurements in a cohort of unsedated hospitalized neonates—A method validation

“…13,15,16 Longitudinal eNO measurements from birth may offer valuable prognostic information. [17][18][19][20] As lungs mature and develop rapidly after birth, it is reasonable to believe that measuring eNO may enlighten some of the processes involved. 7,21 Furthermore, it might help diagnosing neonatal respiratory disorders.…”