Elevated cytokine levels in tracheobronchial aspirate fluids from ventilator treated neonates with bronchopulmonary dysplasia

Bronchopulmonary dysplasia (BPD) is a chronic lung disease often occurring in ventilator-treated very low birth weight infants. The aetiology of BPD is multifactorial and pulmonary immaturity, high oxygen concentrations, peak inspiratory pressure levels and large tidal volumes during prolonged mechanical ventilation are important factors. We measured in tracheobronchial aspirate fluid (TAF) the concentrations of the pro-inflammatory cytokines tumour necrosis factor alpha, interleukin-1 beta (IL-1 beta), IL-6, IL-8, and IL-1 receptor antagonist in infants requiring artificial ventilation for BPD (n = 17) or respiratory distress syndrome (RDS) (n = 15) or postoperatively after surgery (n = 15). The median levels of all studied cytokines in TAF were higher in infants with BPD without local or systemic corticosteroid treatment compared to the median TAF levels of BPD neonates treated with corticosteroids (P = 0.06-P < 0.01). The neonates with BPD not treated with corticosteroids also showed higher levels of the five studied cytokines in TAF compared to infants on short-time ventilator treatment (P < 0.01-P < 0.001) and compared to neonates with RDS (P = 0.07-P < 0.001). The corticosteroid treated neonates with BPD had TAF cytokine levels approaching those of the control neonates. Tumour necrosis factors alpha, IL-1 beta, IL6, IL8 and IL1ra were markedly elevated in tracheobronchial aspirate fluids from neonates with bronchopulmonary dysplasia. Corticoid treatment seemed to reduce these levels.