Schmalisch Gerd, Wilitzki Silke, Fischer Hendrik S, Bührer Christoph
Department of Neonatology, Charité University Medicine, Charitéplatz 1, D - 10117 Berlin, Germany.
BMC Res Notes. 2014 Jun 24;7:389. doi: 10.1186/1756-0500-7-389.
Exhaled nitric oxide (eNO) is a marker of established airway inflammation in adults and children, but conflicting results have been reported in preterm infants when postnatal eNO is measured during tidal breathing. This study investigated the extent to which intubation and mechanical ventilation (MV) affect eNO and NO production (V'NO) in preterm infants with and without bronchopulmonary dysplasia (BPD).
A total of 176 very low birth weight (VLBW) infants (birth weight <1500 g), including 74 (42%) with and 102 (58%) without BPD, were examined at a median postmenstrual age of 49 weeks. Of the 176 infants, 84 (48%) did not require MV, 47 (27%) required MV for <7 days and 45 (26%) required MV for ≥7 days. Exhaled NO and tidal breathing parameters were measured in sleeping infants during tidal breathing, respiratory mechanics were assessed by occlusion tests, and arterialized capillary blood gas was analyzed.
eNO was significantly correlated with tidal breathing parameters, while V'NO was correlated with growth parameters, including age and body length (p < 0.001 each). Infants who were intubated and received MV for <7 days had significantly lower eNO (p < 0.01) and V'NO (p < 0.01) than non-ventilated infants. In contrast, eNO and V'NO did not differ significantly in non-ventilated infants and those receiving MV for ≥7 days. Multivariate analysis showed that independent on the duration of MV eNO (p = 0.003) and V'NO (p = 0.018) were significantly increased in BPD infants comparable with the effects of intubation and MV on eNO (p = 0.002) and V'NO (p = 0.017).
Preterm infants with BPD show only weak postnatal increases in eNO and V'NO, but these changes may be obscured by the distinct influences of breathing pattern and invasive respiratory support. This limits the diagnostic value of postnatal eNO measurements in the follow-up of BPD infants.
呼出一氧化氮（eNO）是成人和儿童已确诊气道炎症的标志物，但在对早产儿进行潮气呼吸时测量出生后eNO时，报告的结果相互矛盾。本研究调查了气管插管和机械通气（MV）对患有和未患有支气管肺发育不良（BPD）的早产儿eNO和一氧化氮生成量（V'NO）的影响程度。
共有176例极低出生体重（VLBW）婴儿（出生体重<1500g）接受了检查，其中74例（42%）患有BPD，102例（58%）未患BPD，检查时的中位孕龄为49周。在这176例婴儿中，84例（48%）不需要MV，47例（27%）需要MV<7天，45例（26%）需要MV≥7天。在睡眠中的婴儿进行潮气呼吸时测量呼出NO和潮气呼吸参数，通过阻断试验评估呼吸力学，并分析动脉化毛细血管血气。
eNO与潮气呼吸参数显著相关，而V'NO与包括年龄和身长在内的生长参数相关（各p<0.001）。插管并接受MV<7天的婴儿的eNO（p<0.01）和V'NO（P<0.01）显著低于未通气婴儿。相比之下，未通气婴儿和接受MV≥7天的婴儿的eNO和V'NO没有显著差异。多变量分析显示，与插管和MV对eNO（p=0.002）和V'NO（p=0.017）的影响相比，BPD婴儿的eNO（p=0.003）和V'NO（p=0.018）在不依赖MV持续时间的情况下显著增加。
患有BPD的早产儿出生后eNO和V'NO仅轻度增加，但这些变化可能因呼吸模式和有创呼吸支持的不同影响而被掩盖。这限制了出生后eNO测量在BPD婴儿随访中的诊断价值。
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