ABSTRACT
INTRODUCTION: The objective of this study was to compare the pulmonary inflammatory response of premature infants with respiratory distress following instillation of one of two commonly available surfactant preparations. METHODS: This was a prospective, randomized investigation of preterm infants who were less than 30 weeks of gestational age, weighed less than 1 kg at birth, and who qualified to receive surfactant. Infants with multiple congenital anomalies or whose mothers were taking anti-inflammatory medications were ineligible. Tracheal aspirates (TAs) were collected on days 1, 3, 5, and 7 and airway cytokines from TAs were assayed for interleukin (IL)-8 and IL-6. RESULTS: Infants were evenly matched by gestation (26+/-2 days and 26+/-1 days [mean+/-SD], Surfactant A and B, respectively) and birth weight (730+/-141 g and 732+/-167 g). TA cytokine levels were not different between or within groups. Ventilator requirements and clinical outcomes were similar between the two groups. CONCLUSION: The postnatal airway inflammatory response observed in preterm infants is not altered by the instillation of either surfactant preparation.
Subject(s)
Cytokines/metabolism , Infant, Premature , Pulmonary Surfactants/therapeutic use , Respiratory Distress Syndrome, Newborn/metabolism , Female , Humans , Infant, Newborn , Interleukin-6/metabolism , Interleukin-8/metabolism , Male , Respiratory Distress Syndrome, Newborn/drug therapy , Respiratory Distress Syndrome, Newborn/physiopathology , Respiratory Physiological Phenomena , Trachea/metabolismABSTRACT
BACKGROUND: An apparent life-threatening event (ALTE) refers to the sudden occurrence of a breathing abnormality, color change, or alteration in muscle tone or mental status in an infant. Several patients with ALTEs admitted to our institution were found to have sustained abusive head injuries. OBJECTIVE: To systematically examine the possible causes of ALTEs and their relative frequencies. STUDY DESIGN: Prospective consecutive case series of 243 infants younger than 12 months admitted to a tertiary care academic medical center for evaluation of an ALTE during a 32-month interval. RESULTS: Thirty-five different causes of ALTEs were identified. Six subjects (2.5%) were diagnosed as having abusive head injuries, or 1 admission every 5 months. Three patients died in the hospital, 2 of whom were diagnosed as having abusive head injuries. CONCLUSIONS: A wide spectrum of diseases and disorders can precipitate an ALTE. Among them, abusive head injury, a recently recognized cause, occurs frequently enough to obligate its inclusion in the differential diagnosis. An ophthalmologic evaluation with dilated fundus examination and cranial imaging should therefore be considered early in the investigation unless another cause becomes apparent soon after admission.