Surfactant Protein D for Pathological Evaluation of Infant Acute Respiratory Distress Syndrome Caused by Respiratory Syncytial Virus Infection

Daisuke Tamura,Ayafumi Ozaki,Takanori Yamagata,Shun Inoue,Takatoshi Oishi

doi:10.4236/ojped.2020.104067

Abstract

Pediatric respiratory syncytial viral infection (RS) usually shows relatively good outcome; however, when it accompanies acute respiratory distress syndrome (ARDS), this becomes fatal. We experienced three pediatric patients with RS + ARDS, with all showing good outcome with steroid pulse therapy. We wish to emphasize; 1) steroid pulse therapy may become an option for this condition, and 2) plasma KL-6 and surfactant protein D levels may become a biomarker reflecting the disease progression/condition. Patients were, aged 1 month, 1 year 5 months, and 1 year 11 months. In all three, the respiratory condition deteriorated rapidly, requiring invasive ventilator management. Although the effectiveness of steroid treatment for ARDS is controversial, very severe condition prompted us to employ steroid pulse therapy, after which, oxygenation rapidly improved without adverse events. Plasma KL-6 and surfactant protein D levels were measured during exacerbations of ARDS, steroid pulse therapy, and recovery. Surfactant protein D levels were closely associated with oxygenation, suggesting this substance level might be a biomarker of ARDS caused by the disruption of the alveolar epithelial lining and to understand oxygenation without time lag.

Highlights

Respiratory syncytial viral infection (RS) is the major cause of lower respiratory tract illness in children [1] [2]
Plasma KL-6 and surfactant protein D levels were measured during exacerbations of Acute respiratory distress syndrome (ARDS), steroid pulse therapy, and recovery
Surfactant protein D levels were closely associated with oxygenation, suggesting this substance level might be a biomarker of ARDS caused by the disruption of the alveolar epithelial lining and to understand oxygenation without time lag

Summary

Introduction

Respiratory syncytial viral infection (RS) is the major cause of lower respiratory tract illness in children [1] [2]. We experienced three pediatric patients with RS + ARDS, with all showing good outcome with steroid pulse therapy. The effectiveness of steroid treatment for ARDS is controversial, very severe condition prompted us to employ steroid pulse therapy, after which, oxygenation rapidly improved without adverse events.

Results

Conclusion