study of some oxidant products and antioxidants in children with acute respiratory distress

ABSTRACT

The present study included sixty pediatric patients with acute respiratory distress, their age ranged from 2 months to 13 years. They were 42 males and 18 females, in addition to twenty apparently healthy children of matchable age, sex and socioeconomic status as control group. All patients were selected from the Intensive care and emergency unit of pediatric department, Assiut University Hospitals. Patients with sepsis or suspected metabolic disease were excluded. Thorough clinical history, examination and chest x-ray were conducted. Laboratory assessments included a peripheral hemogram, serum electrolytes, urea, creatinine, arterial blood gases and estimation of some products of oxidant stress and antioxidants including nitric oxide [s. nitrite], lipid peroxides [LPER], total thiols [glutathione], ceruloplasmin and vitamin E. Out of the 60 patients, 5 cases had viral croup [8.33%], 11 cases had acute viral bronchiolitis [18.33%], 14 children had bronchial asthma [23.33%], 26 cases were diagnosed as bronchopneumonia [43.33%] and 4 cases had lobar pneumonia [6.67%]. No significant difference in arterial blood gases was found between the 5 groups except for PaO[2] which was significantly lower in asthmatic children than in those with bronchopneumonia [P<0.01]. Hemoglobin value was significantly lower and total WBC count was significantly higher in all patients with respiratory distress than controls [P<0.001 for each]. Regarding serum electrolytes, only serum calcium was significantly lower in patients with respiratory distress than controls [P<0.001]. The levels of serum nitrite, lipid peroxides and ceruloplasmin were significantly higher in patients than in controls [P<0.001 for each]. However, serum SOD, total thiols and vitamin E were significantly lower in patients than in controls [P<0.001 for each]. Patients with bronchial asthma showed significantly higher serum nitrite, lipid peroxides and ceruloplasmin and significantly lower total thiols and vitamin E than those with viral croup. Significant positive correlations were noticed between arterial oxygen pressure [PaO[2]] and serum nitrite level and between lipid peroxides and respiratory distress score [P<0.001 for each]. Significant negative correlations were observed between SOD levels fraction of inspired oxygen, between total thiols and either respiratory distress score or Fio2 and between serum vitamin E levels and either respiratory distress score or Fio2 [P<0.001 for each]. Imbalance between endogenous antioxidant systems and oxidant stress with shifting toward oxidant stress may be an underlying pathophysiologic mechanism leading to or aggravating the severity of respiratory distress in airway diseases. Further studies are recommended to delineate the effect of exogenous therapeutic augmentation of antioxidant defenses