| Objective Meconium aspiration syndrome(MAS) is a major respiratory disease related to high morbidity and mortality in neonates. Meconium aspiration before or during birth can obstruct airways,induced lung inflamation and a series of clinical sympotoms. The pathophysiology mechanism of MAS is complex.Cytokines play very important roles in development of MAS.Many cytokines such as Tumor Necrosis Factor-alph(TNF-α),Interleukin-1(IL-1),Interleukin-6(IL-6)were released post meconium aspiration which can induce lung inflamation, and also can cause persistent pulmonary hypertension of the newborn(PPHN).Since 1992 , first time reported that inhaled nitric oxide(iNO) was seceeded in the treatment of PPHN,It was widely researched and used in neonatal respiratory diseases.NO not only could selectively reduce PPHN to improve the oxygenation,but also could down-regulated the expression of proinflammatory factor,inhibit leukocyte aggregation and the release of inflammatory mediators.The purpose of our study was to investigate the effect of inhaled Nitric Oxide(iNO) on pulmonary inflammatory response through the changes of TNF-α,IL-1βin bronchoalveolar lavage fluid and serum,lung function such as oxygenation and gas exchange in MAS.Method Experimental groups(groupNO and groupC) consist of 45 newborns with severe MAS who were treated with mechanical ventilation in neonatal Intensive Care Unit (NICU) of HeBei Province Children Hospital from Mar.2006 to Jan.2008. The patients with an oxygenation index (OI)≥15 were randomized in a non-blinded manner to receive either iNO (NO group, n=22) or no NO (the conventional therapy group, C group,n=23). Eligible patients were treated in the same neonatal unit and received the same standard therapy throughout the study period.25 full-term healthy newborns who were selected randomly in the same hospital were enrolled as H group.Group NO,Group C were taken the BALF and the venous blood 2ml when the NO treatment (0h) or machine ventilation treatment (0h)was received and 24 hours (24h),48 hours (48h) aftter. Arterial blood gas tensions, Parameters of fraction of inspired oxygen (FiO2), OI, mortality, ventilation time, were recorded. Group H were taken 2ml venous blood when enrolled in our study(0h) and 24 hours (24h) ,48 hours (48h) after. The concentration of TNF-αand IL-1βin the the BALF and the venous blood detected by radio-immunity method. The reagent kits for TNF-αand IL-1βradiommunoassay were provided by Beijing north biological technology research institute, the examination step and the method carried on according to which the medicine kit showed.The statistical analysis SPSS10.0 statistics software was used to carry on statistics processing, P<0.05(double side) had statistical significance.Results1 At the beginning of the treatment, no significant differences were detected in the OI and a/A between the two groups. One hour later, OI of NO group decreased significantly (P<0.05),the a/A of groupNO increased significantly (P<0.05),while in C group the difference was not found until 24 hours (P<0.05). There were significant differences in OI and a/A at 1, 24 hours between the two groups(P<0.05).2 Compared to the C group, ventilation time,duration of the need for supplement oxygen and hospital stay (P<0.05) were short (P<0.05).whereas mortality (P>0.05) and incidence of IVH (P>0.05) were not significantly.3 At 0h,24h,48h,TNF-αand IL-1βof GroupNO and GroupC in serum were higher than groupH(P<0.05).At 24h,48h,TNF-αand IL1-βin serum and BALF of groupNO were lower than groupC.(P<0.05).4 The correlation analysis There was no correlation between TNF-αand IL-1βin BALF and those in serum。Conclusions1 iNO effectively improve the oxygenation and shorten the ventilation time and hospital stay without augmentation of risk of IVH and pneumothorax in these neonatal patients. 2 The Mconiusm inspiration potentiated lung injury cause by lung inflammation。3 The beneficial effects of inhaled NO on lung inflammation may be due to inhabition of proinflammatory factor .
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