Pharyngeal pressure value using two continuous positive airway pressure devices

The aim of the study was to measure the difference between the set continuous positive airway pressure (CPAP) value and the pharyngeal pressure reading during CPAP in premature infants with mild respiratory distress syndrome, using two different devices: hood CPAP and the conventional nasal system. The preliminary results suggest that hood CPAP may produce more stable pharyngeal pressure than the conventional nasal devic

Nasal continuous positive airway pressure with heliox in preterm infants with respiratory distress syndrome

To assess the therapeutic effects of breathing a low-density helium and oxygen mixture (heliox, 80% helium and 20% oxygen) in premature infants with respiratory distress syndrome (RDS) treated with nasal continuous positive airway pressure (NCPAP). METHODS: Infants born between 28 and 32 weeks of gestational age with radiologic findings and clinical symptoms of RDS and requiring respiratory support with NCPAP within the first hour of life were included. These infants were randomly assigned to receive either standard medical air (control group) or a 4:1 helium and oxygen mixture (heliox group) during the first 12 hours of enrollment, followed by medical air until NCPAP was no longer needed. RESULTS: From February 2008 to September 2010, 51 newborn infants were randomly assigned to two groups, 24 in the control group and 27 in the heliox group. NCPAP with heliox significantly decreased the risk of mechanical ventilation in comparison with NCPAP with medical air (14.8% vs 45.8%). CONCLUSIONS: Heliox increases the effectiveness of NCPAP in the treatment of RDS in premature infants

Calcium signaling-related proteins are associated with broncho-pulmonary dysplasia progression

Broncho-pulmonary dysplasia (BPD) is a chronic pulmonary disorder that follows premature birth. It is preceded by respiratory distress syndrome (RDS), characterized by acute respiratory failure due to deficiency of surfactant at birth. Clinical characteristics of infants affected by BPD have widely changed in the last decades: they are extraordinarly immature, with impaired alveolar and vascular lung development. To build up new therapeutic strategies for BPD babies, it is necessary to understand the pathogenic mechanisms, which are complicated by environmental risk factors and genetic predisposition. Therefore, the aim of this study was to highlight protein changes in the broncho-alveolar lavage fluid (BALF), thus providing an appropriate picture on what is happening in the locus of injury. We analyzed BALF samples from preterm babies, born at different stages of lung development. We confirmed that gestational age is relevant for BPD progression, but we also detected few de-regulated proteins in the younger babies; we discovered less abundant calcium signaling-related proteins, consistent with BPD severity, comparing severe to mild BPD babies with matched gestational age. In conclusion, this study suggests a subset of proteins to be investigated to better treat BPD babies and facilitate the definition of potential drug targets for novel therapies. BIOLOGICAL SIGNIFICANCE: Pulmonary biomarkers are needed to predict the clinical course of lung disease, status, progression and response to treatment. A key aspect in biomarker discovery is uncovering molecules that appear early during disease initiation, when the natural history of the disease can be modified. Using a proteomic-based approach we compared broncho-alveolar lavage fluid (BALF) protein profile from preterm neonates at different postmenstrual ages, to have a molecular description of broncho-pulmonary dysplasia (BPD) progression. BALF provided a snapshot of local molecular changes, which are relevant for early diagnosis, assessment and characterization of lung disorders. We showed that even if the studied patients had similar clinical phenotype (they all developed severe BPD and they were all cured in the same way in terms of mechanical ventilation, surfactant administration, antenatal steroid treatment and ibuprofen treatment for patent ductus arteriosus), however their BALF protein profiling displayed significant differences in a subset of proteins, which could be exploited to facilitate the development of novel effective therapies, distinct for age and severity of the disease

Proteomic Analysis of BALF in Preterm Infants at High Risk To Develop Bronchopulmonary Dysplasia

BACKGROUND: Bronchopulmonary dysplasia (BPD) is a multi-factorial disease regarded as impaired alveolar and vascular lung development. Bronchoalveolar lavage fluid (BALF) proteome analysis in adults both in normal and pathological conditions has made an important contribution to better understand the molecular mechanisms underlying lung disorders. Proteomic approaches have been reported in few studies of acute lung injury of premature neonates suffering from respiratory distress syndrome (RDS) and subsequent development of BPD, which remains the most frequent chronic morbidity afflicting prematurely born infants. OBJECTIVE: The aim of this study was to assess and compare the proteomic profiles of BALF from premature neonates with and without BPD. DESIGN/METHODS: 14 neonates with gestational age (GA) 6432 weeks were enrolled; they all required intubation for RDS in the first hours of life. BALF samples, according to the duration of intubation, were collected at day 1,3,5,7. In order to get more insight into the molecular mechanisms of BPD development, we compared the comprehensive two-dimensional polyacrylamide gel electrophoresis (2D-PAGE) protein profile of BALF from 11 preterm babies that developed BPD (mean\ub1SD GA 26\ub12 weeks and mean\ub1SD birth weight (BW)875\ub1219 g) with that of 3 babies that did not develop BPD (mean\ub1SD GA 30\ub12 weeks and mean\ub1SD BW 1427\ub178 g). Differentially expressed proteins, as evaluated by image analysis, were identified by mass spectrometry. RESULTS: The proteomic analysis permitted us to identify altered protein levels in the BPD groups of patients. As expected, we found that pro-inflammatory proteins were up-regulated in preterm infants compared to age-matched controls. Moreover we identified few red-ox proteins and some proteins involved in alveolar development and surfactant cleavage, which resulted to be significantly down-regulated in BPD patients. We also validated some of the identified de-regulated proteins by Western Blot analysis. CONCLUSIONS: In conclusion, this study demonstrates the potential of proteomics to study the pattern of BALF proteins in BPD patients. This preliminary data suggested that multiple markers can better describe such a complex diseas

Hypothermia and meconium aspiration syndrome: International multicenter retrospective cohort study

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