Plasma Cytokine Levels Fall in Preterm Newborn Infants on Nasal CPAP with Early Respiratory Distress

Introduction Early nCPAP seems to prevent ventilator-induced lung injury in humans, although the pathophysiological mechanisms underlying this beneficial effect have not been clarified yet. Objective To evaluate plasma levels IL-1 beta, IL-6, IL-8, IL-10, and TNF-alpha immediately before the start of nCPAP and 2 hours later in preterm infants. Methods Prospective cohort including preterm infants with 28 to 35 weeks gestational age with moderate respiratory distress requiring nCPAP. Extreme preemies, newborns with malformations, congenital infections, sepsis, surfactant treatment, and receiving ventilatory support in the delivery room were excluded. Blood samples were collected right before and 2 hours after the start of nCPAP. Results 23 preterm infants (birth weight 1851 +/- 403 grams; GA 32.3 +/- 1.7 weeks) were treated with nCPAP. IL-1 beta, IL-10, TNF-alpha levels were similar, IL-8 levels were reduced in 18/23 preterm infants and a significant decrease in IL-6 levels was observed after 2 hours of nCPAP. All newborns whosemothers received antenatal steroids had lower cytokine levels at the onset of nCPAP than those whosemothers didn't receive it; this effect was not sustained after 2 hours of nCPAP. Conclusion Early use nCPAP is not associated with rising of plasma pro-inflammatory cytokines and it seems to be a less harmful respiratory strategy for preterm with moderate respiratory distress.