CELL COUNTS, CYTOKINES AND CULTURES IN TRACHEAL ASPIRATES OF INFANTS REQUIRING INVASIVE MECHANICAL VENTILATION

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ESPR349
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Abstract: :

Background: Bronchopulmonary dysplasia (BPD) is a chronic lung disease that affects many premature infants. It is well known that duration of invasive mechanical ventilation directly correlates with the degree and severity of BPD in extremely low BW (ELBW) infants. Hence, timely extubation is an important goal. Additionally, a well-known complication of prolonged intubation is the development of bacterial tracheitis which can further prolong duration of mechanical ventilation, confer increased risk of sepsis and increase duration of hospitalization. The definitive diagnosis of bacterial tracheitis is established by direct bronchoscopy via direct visualization. However, this is difficult and impractical to do in the neonatal intensive care unit (NICU) setting. Indicators of bacterial tracheitis may include change in the quantity and quality of tracheal aspirates (TA), increased ventilation support, or TA with moderate-heavy polymorphonuclear cells with moderate-heavy bacterial growth, in the absence of radiographic evidence of new lung infiltrates. When a TA grows an organism in the absence of other clinical signs of tracheitis, it becomes difficult to establish if it is only a colonization or an infection for which the infant requires antimicrobial therapy to eradicate the organism. The significance of tracheal microbial colonization in the neonatal population is not well known.

Objective: Our aim was to correlate information about the presence of polymorphonuclear cells with microbial growth and the cytokine milieu in the TA of infants who have been intubated for >7 days.

Methods: TA were collected from infants who had been intubated for 7 days or longer. Respiratory cultures were performed, and infants were stratified based on the presence and abundance of polymorphonuclear cells and microbial growth. Cytokines were measured in the TA of each of the respective groups.

Results: In the 19 infants whose TA were collected, the presence of at least moderate WBC with presence of microbial growth were positively associated with the presence of IL-10, IL-8, and IL-6. The presence of moderate WBC, with or without microbial growth, was correlated positively with the presence of IL-10, IL-8, IL-6, IL-1β, MCP-1, and TNF-α.  

Conclusion: There is a trend towards higher levels of pro-inflammatory cytokines (especially, IL-10, IL-8, and IL-6), with higher cell counts and presence of microbial growth. The findings suggest that the presence of microbial growth correlated with inflammatory burden and warrants a larger study to see if treatment of microbial growth can ameliorate the inflammatory burden.

The Children's Regional Hospital at Cooper
Drexel University College of Medicine/ St Christopher's Hospital for Children
Drexel University
Drexel University
Drexel University

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