Background and aims: Secretory phospholipase A2 (sPHA2) has been shown to be involved in alveolar inflammation and surfactant degradation in animal models. sPHA2 plays a role in adult RDS, but it has never been studied in human neonates with RDS. Study aim was to investigate sPHA2 activity in newborn lung and its relationship with clinical-laboratory findings of these patients.
Methods: We measured pH and sPHA2 activity in broncho-alveolar lavage fluid (BALF) of 20 newborns with hyaline membrane disease (HMD), 10 with pneumonia/sepsis and 10 ventilated for non pulmonary reasons (NPR). BALF was treated with a previously described procedure, before surfactant administration. In a subset of patients BALF was obtained before/after surfactant administration. sPHA2 activity was measured using an EIA method on microplate.
Results: sPHA2 correlates negatively with dynamic compliance (r = -0.43;p = 0.03), positively with FiO2 (r = 0.48; p = 0.014), MAP (r = 0.4;p = 0.02) and oxygenation index (r = 0.34;p = 0.049). Compliance and sPHA2 activity have a significant logarithmic relationship (p = 0.009). sPHA2 was higher in babies ventilated for sepsis or pneumonia compared to HMD/NPR babies (p = 0.008). Surfactant seems to increase sPHA2 activity (p = 0.028) and its own catabolism. sPHA2 was independent from alveolar pH.
Conclusions: These are the first data about the role of sPHA2 in neonatal critical respiratory diseases. sPHA2 plays a role in the development of clinical pictures in such diseases and is associated with the lung stiffness. This is more pronounced in infection-related respiratory failure. sPHA2 may be associated with the need for surfactant during mechanically ventilated sepsis or pneumonia; further researches are warranted about the interaction surfactant/sPHA2.
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