Oxidant injury and release of proteolytic enzymes in prematures with respiratory distress syndrome (RDS), who are treated with ventilators and oxygen, have been postulated as possible causes of bronchopulmonary dysplasia (BPD). The premature may be at particular risk due to low levels of antiproteases, such as alpha-1-proteinase inhibitor (α1PI), and antioxidants, such as ceruloplasmin (CER). Both α1PI and CER deficiencies have been correlated with the severity of RDS. We studied serial α1PI activity measured by trypsin inhibitory capacity (TIC) and CER in the serum 27 prematures who required ventilatory therapy for RDS. Serum TIC values for day 1 were significantly lower (0.34 vs. 0.92 mg inhibited/ml of sample) in the 13 patients who developed BPD compared to the 14 who did not. No significant differences were seen on succeeding days. No significant differences in CER were seen, although both groups had levels 33-50% of adult normals (11.3 vs 9.3 mg/dl). Other significant variables included birthweight (p < 0.005), severity of RDS (p < 0.03), and gestational age (p < 0.03). One way analysis of variances demonstrated day 1 TIC to be the most significant variable (p < 0.0001), followed by weight (p < 0.007), severity RDS (p < 0.04), and gestational age (p < 0.03). CER levels were not a significant variable. A formula utilizing unstandardized canonical discriminant function including day 1 TIC, birthweight, severity of RDS, and gestational age was 100% sensitive and 85% specific in the prediction of BPD for the original study group. In an additional 25 consecutive admissions with severe RDS of whom 18 survived, the formula was 100% sensitive (6/6) and 75% specific (9/12). Decreased TIC on day 1 may be of pathogenetic and prognostic significance in the development of BPD.
|Original language||English (US)|
|Number of pages||4|
|Journal||American Review of Respiratory Disease|
|State||Published - 1986|
All Science Journal Classification (ASJC) codes
- Pulmonary and Respiratory Medicine