Preditores clínicos e laboratoriais para displasia broncopulmonar em recém-nascidos pré-termo de muito baixo peso ao nascer

Abstract

Background: Bronchopulmonary dysplasia (BPD) is a multifactorial disease that has specific clinical, radiological and histological features, defined as the oxygen dependence at concentrations above 21% for a period ≥ 28 days and / or at 36 weeks post- menstrual. Currently, there are no clinical parameters or biomarkers for its prediction. Objective: To identify clinical and laboratory biomarkers predictive of bronchopulmonary dysplasia in very low birth weight preterm infants. Methods: We analyzed a prospective cohort of 40 neonates with gestational age <34 weeks, weighing <1500 g, and who did not present congenital malformations. Preterm infants were divided into two groups: 19 without BPD and 21 with BPD. An analysis of the clinical variables, blood collection between 36 and 48 h of life, and quantification of two cytokines (GM-CSF and eotaxin) were performed through a multiplex system. Results: Maternal characteristics were homogeneous, and among neonatal characteristics, the time of mechanical ventilation was critical for development of the disease. The two cytokines were highly significant on the second day of life; GM-CSF levels presented a significantly higher values in the BPD group (p = 0.002), while eotaxin presented higher levels in the group without BPD (p = 0.02). The ratio between GM-CSF and eotaxin determined 100% sensitivity and 80% specificity for IMV (ROC area = 0.9013, CI = 0.7791–1.024, p< 0.0001). Conclusions: The IMV duration time performed in the first 48 hours of life in the low birth weight neonates is a significant clinical predictor of BPD. The use of continuous IMV is associated with increased ratios between GM-CSF and eotaxin, suggesting increased lung injury and consequently progression of the disease.