Immediate Postnatal Serum Tumor Necrosis Factor-Alpha Concentration and the Development of Bronchopulmonary Dysplasia

ABSTRACT

PURPOSE: We tested the hypothesis that preterm infants who develop bronchopulmonary dysplasia (BPD) have higher concentration of serum tumor necrosis factor-alpha (TNF-alpha) within 8 hours after birth than those who do not. METHODS: Serum and tracheal aspirate (TA) TNF-alpha concentrations were measured by enzyme-linked immunosorbent assay in the thirty-four preterm infants born before 32 weeks of gestation. Multiple logistic regression analysis was done. RESULTS: Median concentrations of both serum and TA TNF-alpha were higher in BPD group than in non BPD group [serum TNF-alpha, 214.52 pg/mL (84.20-244.20) versus 100.07 pg/mL (78.43-225.52), P=0.037],[TA TNF-alpha, 13.12 pg/mL (10.43-64.67) versus 11.58 pg/ mL (9.76-58.53), P=0.038]. After making adjustments for the effects of gestational age at birth, 5 minute Apgar score less than 7 and histologic chorioamnionitis, only serum TNF-alpha concentration was independently significant [P=0.045 Odds ratio, 1.381 95% confidence interval, 1.007-1.895]. The diagnostic indices of TNF-alpha (cutoff, 97.1 pg/mL) as a predictor of development of BPD were sensitivity of 85.7%, specificity of 38.5%, positive predictive value of 69.2%, negative predictive value of 62.5% (P=0.037). CONCLUSION: Increased serum TNF-alpha concentration within 8 hours after birth may be a significant risk factor of later development of BPD.