الفهرس 
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Abstract
Bronchopulmonary dysplasia continues to be an important problem in premature infants despite improved facilities of care, monitoring and treatment. The etiology of BPD is still unknown but large numbers of factors are suggested to be involved in the development of the disease and thought to be of multifactorial origin of which oxygen is one factor. The objective of this study is to measure the level of a potent pro fibrotic cytokinetransforming growth factor beta1 (TGF-β1) in cases of respiratory distress syndrome, evaluating its role as a predictive marker for the development of chronic lung disease of prematurity (CLD). This study was carried out on forty five (45) preterm newborns selected from those admitted to Neonatal Intensive Care Unit (NICU) at Benha University Hospital and Benha Children Hospital during the period from July 2010 to October 2011. Their gestational age ranged between 28-35 weeks. Neonates were divided into 3 groups:
• Group I: It included15 neonates who develop BPD.
• Group II: It included 15 neonates who diagnosed as ARD.
• Group III: 15 control healthy preterm newborns.
The preterm infants were subjected to:
• Full medical history
• Full physical examination
• Respiratory data was recorded; mode of assisted ventilation, pressures, means FiO2, flow rate, duration of assisted ventilation. Surfactant use was not noted.
• Echocardiography for detection of PDA if suggested.
• Chest X-ray will be done for detection of RDS and bronchopulmonary dysplasia.
• Sepsis was diagnosed by using clinical and hematological septic score.
• Preterm neonates were followed up in the NICU for development of BPD defined as oxygen therapy ≥28 days to maintain an adequate range of oxygen saturation.
• Measurement of the level of TGFβ1: venous blood samples were obtained centrifuged and separated on the first day of admission for the three groups, 5-7 days later for group I and group II and on 28 day after admission for group I to measure TGF-β1 using DRG TGF-β1 ELISA kit.
The results showed that:
According to the severity of BPD, 3 cases presented with mild BPD (20%), 5 cases presented with moderate (33, 3%) and 7 cases with severe BPD (46, 7%).
There was significant association between development BPD and birth weight, gestational age, absence of prenatal corticosteroids, duration of mechanical ventilation, total number of days of oxygen therapy, FIO2, sepsis score and positive CRP.
There was no significant association between BPD and sex, mode of delivery, etiology of prematurity, PIP, PEEP, history of asphyxia and presence of PDA.
There was significant difference between group I and both group II and group III as regard to the level of TGF-β1 in day 1.
There was significant difference between group I and group II as regard to the level of TGF-β1 in day 5-7.
There was significant correlation between TGF-β1 in day 1 in group I and GA, WT and use of corticosteroids.
There was no significant correlation between TGF-β1 in day 1 in group I and parameters of mechanical ventilation, sex and mode of delivery.
There was no significant correlation between TGF-β1 in day 5-7 and day 28 in group I and different variables (GA, WT, use of corticosteroids, parameters of mechanical ventilation, sex and mode of delivery).
There was significant correlation between FIO2 and the level of TGF-β1 in day 1,day5-7 and day 28 in group I and significant correlation between FIO2 and the level of TGF-β1 in day 1,day5-7 group II.
There was no significant correlation between TGF-β1 in day1, day 5-7, day28 in group I and presence of PDA, presence of asphyxia, sepsis score system and severity of BPD.
According to ROC curve using TGF-β1 at days 1=4.005 mg/dL as a cutoff value to predict risk for subsequent development of BPD, with high sensitivity 93% and specificity of 93% and this level is useful in predicting the increased risk for development of BPD as positive predictive value was 93% while negative predictive value was 93%.
Using TGF-β1 at days 5-7= 1.335 mg/dL as a cutoff value to predict risk for subsequent development of BPD, with high sensitivity 100% and specificity of 73% and this level is less useful in predicting the increased risk for development of BPD as positive predictive value was 79% while negative predictive value was 100%.