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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Proinflammatory cytokines in a newborn: a literature review

Abstract

Inflammation is a protective response to infection or injury. The inflammatory response is controlled primarily by cytokines, which are endogenous mediators of the immune system. Cytokines are produced by various different cell types in response to multiple types of stimuli and have overlapping biologic activity. Cytokines also are directly involved in the activation of cells at the inflammatory site. Movement of leukocytes to the inflammatory site is directed along a chemotactic gradient, where the strongest concentration of chemoattractants is at the site of inflammation. Cytokines are involved at each step of this process and act both locally and systemically to initiate, maintain, and finally resolve the inflammatory response. The interplay among these proinflammatory cytokines, antiinflammatory cytokines, and naturally occurring cytokine inhibitors determines the inflammatory response and its effectiveness. Because of the immaturity of the immune system of newborn cytokine is specific. Tumor necrosis factor- (TNF-) and interleukin-6 (IL-6) amplify the immune response through activation of the cytokine cascade and the production of other proinflammatory cytokines and chemokines. In a group of proinflammatory cytokines TNF- and IL-6 have undoubtedly significant role in the cytokine cascades of physiological and pathophysiological responses.

Key words: interleukin-6, tumor necrosis factor-alpha, newborn

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Prenatal and postnatal risk factors for developing bronchopulmonary dysplasia

Abstract

Aim. To determine prenatal and postnatal risk factors for developing bronchopulmonary dysplasia in infants < 30 weeks of gestational age.
Methods. Over a 22-month period, 115 newborns were enrolled in the study. Details including gestational age, sex, birth weight, prenatal steroids, surfactant treatment, ventilatory support, days of postnatal oxygen requirement, late onset sepsis/pneumonia, air leaks, patency of ductus arteriosus, and fluid intake were collected. The presence of chorioamnionitis was diagnosed by histological examination. Commercial ELISA kits were used for the determination of the IL-6 and IL-8 levels.
Results. Twenty-five infants developed BPD and 90 were enrolled in the non BPD group. Lower gestational age and male sex increased the risk for BPD. There was no difference in the presence of chorioamnitis and the level of IL-6 and IL-8 measured in cord blood and gastric aspirate between the groups. Intubation in the delivery room (resuscitation), need for surfactant treatment, mechanical ventilation, late onset sepsis/pneumonia, increased oxygenation index increased the risk for BPD after adjustment for GA and gender.
Conclusion. In our cohort of infants with GA < 30 weeks exposure to prenatal inflammation did not increase the risk for BPD. However, low gestational age, male sex, need for resuscitation, mechanical ventilation and late onset sepsis were major risk factors for BPD development.

Key words: premature infant, bronchopulmonary dysplasia, respiratory distress syndrome, chorioamnionitis, interleukin 6, interleukin 8

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