Secretory phospholipase A2 and neonatal respiratory distress: pilot study on broncho-alveolar lavage

• Published in: Intensive care medicine 2008-10, Vol.34 (10), p.1858-1864, Article 1858
• Main Authors: De Luca, Daniele, Baroni, Silvia, Vento, Giovanni, Piastra, Marco, Pietrini, Domenico, Romitelli, Federica, Capoluongo, Ettore, Romagnoli, Costantino, Conti, Giorgio, Zecca, Enrico
• Format: Article
• Language: English
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthesiology; Apgar score; Babies; Biological and medical sciences; Birth weight; Bronchoalveolar Lavage Fluid - chemistry; Case-Control Studies; Critical Care Medicine; Disease; Emergency and intensive respiratory care; Emergency Medicine; Enzymes; Female; Gestational age; Hospitals; Humans; Hyaline Membrane Disease - enzymology; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Intensive; Intensive care; Intensive care medicine; Lavage; Male; Medical sciences; Medicine; Medicine & Public Health; Newborn babies; Pain Medicine; Pediatric Original; Pediatrics; Phospholipases A2, Secretory - analysis; Pilot projects; Pneumology/Respiratory System; Pneumonia; Pneumonia - enzymology; Prospective Studies; Respiratory distress syndrome; Sepsis; Sepsis - enzymology; Signs; Surfactants; Urine; Vagina; Ventilators
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-008-1224-3

Purposes Secretory phospholipase A2 hydrolyzes phosphoglycerides and it has been shown to be involved in alveolar inflammation and surfactant degradation. It plays an important role in acute lung injury but it has never been studied in newborn infants. We were aimed to investigate the phospholipase A2 activity in neonatal lung injury and its relationship with ventilatory findings. Setting Third level university hospital NICU. Methods We measured phospholipase activity in broncho-alveolar lavage fluid of 21 neonates with hyaline membrane disease, 10 with pneumonia or sepsis and 10 controls, ventilated for extrapulmonary reasons. Fluid was obtained before surfactant administration on the first day of life and phospholipase activity was measured using an ultrasensitive enzymatic method. Before lavage, lung mechanics in pressure controlled synchronized intermittent mandatory ventilation was analyzed. Results Phospholipase A2 was higher in babies ventilated for sepsis/pneumonia compared to hyaline membrane disease and to control babies. Phospholipase correlated negatively with dynamic compliance, positively with inspired oxygen fraction, mean airway pressure and oxygenation index. These correlations still remained significant after multivariate analysis, adjusting for possible confounding factors. Phospholipase was not correlated with blood and alveolar pH, gestational age, birth weight, blood gases, Apgar score, tidal volume, surfactant need and ventilation time. Conclusions These are the first data about phospholipase A2 in neonates. The enzyme plays a role in neonatal lung injury, especially in infection related respiratory failure. It is associated with lung stiffness, higher mean airway pressure and need for oxygen.