RESUMEN
A newborn male with pulmonary edema was delivered at term by elective Caesarian section.ãCytokine profiles of 17 cytokines and KL-6 in cord blood and serial serum values were investigated. The cord blood values of all 17 cytokines and KL-6 were within normal limits.ãSubsequently, IL-6, IL-8, IL-10, IL-13, IL-17, and IFNγ rapidly elevated during the first several hours after birth and dramatically decreased thereafter, whereas KL-6 rose to 611 U/ml on the 3rd day of life and then gradually decreased.ãThese cytokines may induce pulmonary permeability, and KL-6 secreted in lining fluid could result in influx into the bloodstream.ãThis is the first report that we have differentiated neonatal pulmonary edema from TTN by the measurement of serial cytokine profiles and KL-6 in serum.
Asunto(s)
Citocinas/sangre , Mucina-1/sangre , Edema Pulmonar/congénito , Sangre Fetal/inmunología , Humanos , Recién Nacido , Masculino , Permeabilidad , Edema Pulmonar/sangre , Edema Pulmonar/inmunología , Taquipnea Transitoria del Recién Nacido/sangre , Taquipnea Transitoria del Recién Nacido/inmunologíaRESUMEN
Repeated chest radiography is required for the diagnosis and follow-up of neonates with respiratory distress syndrome (RDS) and carries the risk of radiation hazards. Lung ultrasound (LUS) is a non-invasive bedside diagnostic tool that has proven to be effective in the diagnosis of RDS. Our aim was to assess the role of LUS with respect to the standard chest X-ray (CXR) in the detection of complications of RDS in neonates. Ninety premature newborns of both genders with RDS (mean gestational age = 29.91 ± 1.33 wk) and 40 premature babies as a control group were involved in this study. All patients underwent initial clinical assessment as well as CXR and LUS. Those who presented with respiratory distress and/or exhibited deterioration of oxygenation parameters were followed by CXR and, within 4 h, by LUS. Alveolo-interstitial syndrome and pleural line abnormalities were detected in all cases (100%) in the initial assessment, patchy consolidation was detected in 34 cases and white lung was detected in 80 cases. Alveolo-interstitial syndrome was detected in 19 controls. In follow-up of the patients, LUS was superior to CXR in detection of consolidation and sub-pleural atelectasis, but not in detection of pneumothorax. We concluded that bedside LUS is a good non-hazardous alternative tool in the early detection and follow-up of RDS in the neonatal intensive care unit; it could be of value in reducing exposure to unnecessary radiation.
Asunto(s)
Enfermedades Pulmonares Intersticiales/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Derrame Pleural/diagnóstico por imagen , Edema Pulmonar/diagnóstico por imagen , Síndrome de Dificultad Respiratoria del Recién Nacido/diagnóstico por imagen , Ultrasonografía/métodos , Femenino , Humanos , Recién Nacido , Enfermedades Pulmonares Intersticiales/congénito , Masculino , Derrame Pleural/congénito , Edema Pulmonar/congénito , Reproducibilidad de los Resultados , Síndrome de Dificultad Respiratoria del Recién Nacido/complicaciones , Sensibilidad y EspecificidadRESUMEN
OBJECTIVE: To study fetal lung maturity (FLM) as determined by amniotic fluid (AF) tests in diabetic pregnancies (DP) under euglycemic metabolic control, in comparison with matched controls (C). PATIENTS AND METHODS: From 514 consecutive pregnancies where amniocentesis was performed for FLM assessment, we selected 45 glycemic controlled DP. Nineteen DP were Type I (IDDM) and 26 pregnancies were diagnosed Type III (GDM). Cases were matched to C by therapy with corticosteroids, gestational age at amniocentesis, pregnancy complications other than diabetes and gender. FLM was determined by the shake test and lamellar bodies (LB) count, lecithin/sphingomyelin (L/S) ratio (planimetric and stechiometric) and phosphatidylglycerol presence (PG). DP were further sub-divided according to gestational age period at amniocentesis, type of diabetes, associated therapy and fetal malformations. RESULTS: RDS (n=2) and neonatal wet lung (n=5) were diagnosed in neonates from diabetic mothers. We found no statistical difference when comparing FLM indices between DP and C groups: shake test 3.1:1+/-1.2 vs. 2.7:1+/-1.2, P<0.40; planimetric L/S 3.4+/-1.4 vs. 3.1+/-2.0, P<0.27; stechiometric L/S 8.2+/-7.4 vs. 7.1+/-6.1, P<0.54; percentage of PG positivity 57% vs. 46%, P<0.13; lamellar bodies count (X10(3)/microl) 42.8+/-36.9 vs. 41.5+/-30.4, P<0.72. No differences were found between DP and controls for subgroups according to gestational age, type of Diabetes (IDDM or GDM), congenital lesions and associated therapy. CONCLUSIONS: In euglycemic, metabolically controlled diabetic patients FLM is not delayed, however an increased risk for neonatal wet lung should be considered.
Asunto(s)
Diabetes Mellitus Tipo 1/fisiopatología , Diabetes Gestacional/fisiopatología , Pulmón/embriología , Embarazo en Diabéticas/fisiopatología , Amniocentesis , Estudios de Cohortes , Diabetes Mellitus Tipo 1/terapia , Diabetes Gestacional/terapia , Desarrollo Embrionario y Fetal , Femenino , Humanos , Recién Nacido , Masculino , Embarazo , Resultado del Embarazo , Embarazo en Diabéticas/terapia , Edema Pulmonar/congénito , Estudios RetrospectivosRESUMEN
A 9-month-old male with asplenia and complex congenital heart disease experienced progressive stenosis of an anomalous pulmonary venous connection. He developed pulmonary edema and growth failure. Two stents were placed concentrically to relieve the stenosis, and the pulmonary edema and growth failure resolved. Definitive surgery was accomplished 8 months later.
Asunto(s)
Angioplastia de Balón/instrumentación , Cardiopatías Congénitas/terapia , Edema Pulmonar/congénito , Venas Pulmonares/anomalías , Enfermedad Veno-Oclusiva Pulmonar/congénito , Stents , Angiografía , Cardiopatías Congénitas/diagnóstico por imagen , Humanos , Lactante , Masculino , Edema Pulmonar/diagnóstico por imagen , Venas Pulmonares/diagnóstico por imagen , Enfermedad Veno-Oclusiva Pulmonar/diagnóstico por imagen , Enfermedad Veno-Oclusiva Pulmonar/terapiaRESUMEN
Leukotriene B4 (LTB4) has been reported to promote the formation of lung oedema when infused into the pulmonary circulation of adult animals. The present study evaluated the hypothesis that LTB4 was responsible, in part, for the oedema that develops during oxidative injury of the immature lung. Significant increases were found in LTB4 concentration in bronchoalveolar lavage fluid obtained from pre-term guinea pig pups maintained in 95% oxygen for 48 h (P < 0.05) and 72 h (P < 0.05) compared to pups maintained in 21% oxygen. Cellular analysis of lavage fluid revealed a concurrent influx of neutrophils into the hyperoxic-injured lung at these times. The protein concentration of lavage fluid was also increased by 48-h hyperoxia exposure indicating elevated pulmonary microvascular permeability. In a second series of experiments, pups exposed to 95% oxygen (and 21% oxygen controls) were treated with a specific LTB4 antagonist (U-75302), at either 0.5, 1.5 or 3.0 mg 100 g body wt to ascertain if LTB4 played a role in either neutrophil recruitment or oedema formation in the immature lung. The number of neutrophils recovered in bronchoalveolar lavage fluid was significantly reduced, compared to vehicle-treated pups, in pups treated with U-75302, at both 1.5 and 3.0 mg/100 g body wt but not 0.5 mg/100 g body wt. Histopathological analysis of pups treated with 1.5 mg U-75302/100 g body wt revealed fewer neutrophils in the pulmonary interstitium (198 vs. 218 mm-2, P < 0.05). The extent of lung microvascular permeability, elevated by hyperoxic exposure, was modulated by increasing concentrations of U-75302. Specifically, treatment with 0.5, 1.5 and 3.0 mg U-75302/100 g body wt reduced microvascular permeability by 17, 67 and 98%, respectively. In conclusion, LTB4 plays an important role in oedema formation in acute oxidative injury of the immature lung and this is mediated, in part, through neutrophils.