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Klin Padiatr 2011; 223(07): 414-418
DOI: 10.1055/s-0031-1295436
Original Article
© Georg Thieme Verlag KG Stuttgart · New York

Serum Cytokine Levels in Neonates with Congenital Diaphragmatic Hernia

Zytokinkonzentrationen im Serum von Neugeborenen mit angeborener Zwerchfellhernie
T. Schaible
1   Pediatrics and Adolescent Medicine, University Medicine Mannheim, Germany
,
M. Veit
1   Pediatrics and Adolescent Medicine, University Medicine Mannheim, Germany
,
J. Tautz
1   Pediatrics and Adolescent Medicine, University Medicine Mannheim, Germany
,
S. Kehl
2   Obstetrics and Gynecology, University Medicine Mannheim, Germany
,
K. Büsing
3   Clinical Radiology and Nuclear Medicine, University Medicine Mannheim, Germany
,
D. Monz
4   Center of Pediatrics and Neonatology, University of the Saarland, Homburg, Germany
,
L. Gortner
4   Center of Pediatrics and Neonatology, University of the Saarland, Homburg, Germany
,
E. Tutdibi
4   Center of Pediatrics and Neonatology, University of the Saarland, Homburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
24 November 2011 (online)

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Abstract

Objective:

Cytokines play an important role in immune regulation and fetal lung development. The systemic inflammatory response in newborns with congenital diaphragmatic hernia (CDH) has not been characterized so far. We compared various concentrations of cytokines in serum from newborns with CDH and in healthy term neonates. We analyzed cytokine patterns of CDH newborns under extracorporeal membrane oxygenation (ECMO) and mechanical ventilation (MV).

Methods:

38 newborns with CDH were included: ECMO group (n=13) and non-ECMO group (n=25). Healthy term neonates served as controls (n=13). Serum samples were obtained prospectively after birth and during therapy.

Results:

Concentrations of IFN-α, IL-3,-6,-7,-8,-10, MIP-1α,-1β and TNF-α in serum of newborns with CDH were higher than in umbilical cord blood of term neonates. Infants with severe CDH requiring ECMO therapy had higher postnatal IL-8,-10, and MIP-1α levels than newborns with milder disease in the non-ECMO treated group. IL-10 progressively decreased during the first 3 days following birth under ECMO. In contrast, the chemokine MIP-1α remained elevated during ECMO therapy compared to mechanically ventilated CDH newborns.

Conclusions:

The pattern of cytokines in the serum of newborns with CDH showed significant elevations compared to term neonates. Our findings indicate that CDH is associated with systemic inflammatory response immediately after birth. ECMO and MV show a similar increase of IL-1α and IP-10 in CDH newborns assuming a persistent pulmonary inflammatory reaction irrespective of the conducted treatment.

Zusammenfassung

Zielsetzung:

Zytokine spielen eine wichtige Rolle in der Immunregulation sowie der Entwicklung der fetalen Lunge. Wir haben verschiedene Zytokinkonzentrationen im Serum Neugeborener mit einer angeborenen Zwerchfelhernie (CDH) bestimmt und mit gesunden Reifgeborenen verglichen. Weiterhin wurde der Einfluss extrakorporaler Membranoxygenierung (ECMO) und maschineller Beatmung (MV) auf die Zytokinspiegel von Neugeborenen mit CDH analysiert.

Methode:

38 Patienten mit CDH wurden eingeschlossen: ECMO-Gruppe (n=13) und Nicht-ECMO-Gruppe (n=25). Gesunde Reifgeborene dienten als Kontrollen (n=13). Serumproben wurden sowohl nach der Geburt als auch während der Therapie entnommen.

Ergebnisse:

IFN-α, IL-3,-6,-7,-8,-10, MIP-1α,-1β und TNF-α lagen in der CDH-Gruppe in höherer Konzentration vor als im Nabelschnurblut gesunder Reifgeborener. Eine schwere CDH mit ECMO-Therapie war mit höheren IL-8,-10 und MIP-1α-Konzentrationen postnatal assoziiert als in der Nicht-ECMO-Gruppe. Unter der ECMO-Therapie trat eine Abnahme der IL-10-Konzentration während der ersten 3 Tage nach der Geburt ein. Im Gegensatz dazu konnte unter der ECMO-Therapie im Vergleich zur rein MV für das Chemokin MIP-1α keine Abnahme im Zeitverlauf festgestellt werden.

Zusammenfassung:

Die Zytokinprofile im Serum Neugeborener mit CDH zeigten signifikant erhöhte Konzentrationen im Vergleich zu denen gesunder Reifgeborener. Unsere Ergebnisse deuten darauf hin, dass die CDH mit einer unmittelbar postnatal beginnenden systemischen Immunantwort einhergeht. Bei Neugeborenen mit CDH zeigten sich sowohl bei ECMO als auch bei MV vergleichbare Zunahmen an IL-1α und IP-10, was auf eine persistierende pulmonale Entzündungsreaktion unabhängig von der angewandten Therapie hindeutet.

Key words

cytokines - congenital diaphragmatic hernia - neonate - extracorporeal membrane oxygenation

Schlüsselwörter

Zytokine - Zwerchfellhernie - Neugeborene - extrakorporale Membranoxygenierung
 

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