Neutrophil Elastase (E) seems to play an important role in the pathogenesis of chronic lung disease (CLD) in premature infants; acute effects of this neutral protease on neonatal pulmonary disease have not been evaluated. In this prospective study we have analyzed E and α1-Proteinase-activity (α1-PI) in tracheal aspirates of 140 neonates with severe RDS (FiO2 > 0.6, mechanical ventilation) during the first day of life; all infants were treated with natural porcine surfactant (Curosurf).Results: In 42 infants (30 % [group 1]) a considerable activity of E was detected (0.8 - 253 μg/mg albumin, range); in 98 neonates (70 % [group 2]), who had protective levels of α1-PI, no E was found. Characteristics and disease severity were identical in both groups. Gestational age: 29.3 ± 2.3 weeks (group 1); 29,7 ± 2,2 (group 2). Using logistic regression analysis, 28 day outcome data of both groups showed an increased incidence of pulmonary interstitial emphysema (PIE) in patients with E-activity in tracheal aspirates (31.7 % vs. 17.5 %, group 1 vs. group 2, p < 0.05). The incidence of pneumothorax, CLD and non-pulmonary complications was identical in both groups.We conclude that Elastase present in the bronchoalveolar space of infants with RDS is associated with an increased risk of PIE.
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