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Am J Perinatol 2017; 34(07): 648-654
DOI: 10.1055/s-0036-1597133
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Are Cytokines Useful Biomarkers to Determine Disease Severity in Neonates with Congenital Diaphragmatic Hernia?

Thomas Schaible
1   Department of Neonatology, University Hospital Mannheim, Mannheim, Germany
,
Janine Reineke
1   Department of Neonatology, University Hospital Mannheim, Mannheim, Germany
,
Ludwig Gortner
2   Department of Neonatology, University Hospital Saarland, Homburg, Germany
,
Dominik Monz
2   Department of Neonatology, University Hospital Saarland, Homburg, Germany
,
Regine Schaffelder
3   Department of Gynaecology, University Hospital Mannheim, Mannheim, Germany
,
Erol Tutdibi
2   Department of Neonatology, University Hospital Saarland, Homburg, Germany
› Author Affiliations
Further Information

Publication History

14 April 2016

25 October 2016

Publication Date:
07 December 2016 (online)

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Abstract

Background This study investigates plasma cytokine levels in neonates with the more common left-sided congenital diaphragmatic hernia (CDH) and correlates them with severity of disease indicated by position of the liver. An intrathoracic part of liver is associated with higher need for extracorporeal membrane oxygenation (ECMO) and higher risk for chronic lung disease (CLD).

Methods A total of 28 newborns with CDH were subdivided by their liver position in partially intrathoracic (n = 16) and only abdominal (n = 12) position. Only liver-up patients went on ECMO (n = 9) and developed severe/moderate CLD (n = 5). Controls consisted of 19 healthy matched-term neonates. Laboratory samples were extracted from umbilical cord blood and during the neonatal period.

Results In umbilical cord blood, CDH patients showed decreased IL-8 values while MIP-1a (macrophage inflammatory protein-1) values were increased. Concerning the severity of CDH, we measured significantly higher levels of TGFb2 in CDH patients with liver-up than in liver-down cases and controls (p < 0.006). During the neonatal period, the concentration of IL-10 and vascular endothelial growth factor (VEGF) showed significant deviations in the liver-up group with need for ECMO (p < 0.009).

Conclusion In neonates with CDH, plasma cytokine levels are already altered in utero. TGFb2 may work as an early predictor for severity of disease. VEGF and IL-10 could serve as potential biomarkers predicting the course of disease in CDH.

Keywords

congenital diaphragmatic hernia - cytokines - predictive value - umbilical cord blood - liver herniation
 

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