Predictive impact of cytokine profiles on neonates born with a congenital diaphragmatic hernia (CDH)

Abstract

Aims: Children born with a CDH often need an extracorporeal membrane oxygenation (ECMO) in addition to artificial respiration. The fetal lung volume of the unborn child is used to assess the need for an ECMO-therapy. Nevertheless, due to the variability of pulmonary hypertension, it is not possible to clearly predict if a child will need ECMO or not. This study is about the question if cytokine levels can predict ventilator-induced lung injury and the degree of pulmonary hypertension and therefore help to decide if an ECMO-therapy is necessary. Methods: Multiplex bead-assay analysis has been used to measure 26 cytokines simultaneously between two study groups: a CDH with ECMO-therapy group (N=16) and a group without ECMO-therapy but conventional ventilation (N=27). Healthy newborns (N=43) served as controls. Results: The concentrations of cytokines of the children born with a CDH are statistically different from the cytokine levels of the healthy neonates in the control group. Comparing the cytokine levels of children with ECMO to cytokine concentrations of neonates without ECMO-therapy on the day before ECMO-beginning, there are two differing cytokines: IL–8 and IL–10. The concentration of these two interleukins is significantly higher in the group of newborns with the need of ECMO than in the group of children without ECMO necessity. Furthermore the anti-inflammatory IL–10 is decreasing during ECMO-therapy, indicating that pulmonary condition is improving. Conclusion: To conclude, the preparation of a cytokine profile of patients born with a CDH can have a predictive use concerning the need for an ECMO-therapy: If a patient has high levels of IL–8 an IL–10, ventilation should not be intensified, but ECMO-therapy ought to be taken into consideration at an early stage to prevent further ventilator-induced lung injury and to overwhelm pulmonary hypertension. The decrease in IL–10 levels during ECMO-therapy may be an indicator for the success of ECMO treatment.