Plasma endothelin-1 and clinical manifestations of neonatal sepsis
-
José Figueras-Aloy
Abstract
Aim: To determine whether plasma endothelin-1 (ET-1) relates to clinical manifestations of sepsis in the newborn, especially with systemic hypotension, acidosis, severe hypoxemia (which may represent pulmonary hypertension) and oliguria.
Methods: Prospective study of 35 consecutive newborns with clinical sepsis: 22 with hemoculture-positive (HC+) sepsis and 13 hemoculture-negative (HC–). Plasma ET-1 concentrations were measured within 2 days of the diagnosis of sepsis. SNAP-II severity score was performed at the time of highest clinical severity.
Results: Newborns with HC+ sepsis had higher plasma ET-1 concentrations and SNAP-II scores (especially PO2/FiO2ratio) than HC– septic children. Plasma ET-1 concentrations increased linearly with each item of the SNAP-II score, but only reached significant differences in lowest mean blood pressure (P=0.030), lowest pH (P=0.048), multiple seizures (P=0.010) and lowest urine output (P=0.013). Leukocyte count, immature/total neutrophil ratio and C-reactive protein value were not different. Each item of the SNAP-II score was independently related only to ET-1 level. Oliguria, acidosis and systemic hypotension were more correlated (R2>0.5).
Conclusions: Plasma ET-1 levels in neonatal sepsis are related to the severity of clinical manifestations, especially oliguria, acidosis and systemic hypotension.
References
1 Avontuur JA, F Boomsma, AH Van den Meiracker, FH De Jong FH, HA Bruining: Endothelin-1 and blood pressure after inhibition of nitric oxide synthesis in human septic shock. Circulation99 (1999) 271Search in Google Scholar
2 Battistini B, MA Forget, D Laight: Potential roles for endothelins in systemic inflammatory response syndrome with a particular relationship to cytokines. Shock5 (1996) 167Search in Google Scholar
3 Dschietzig T, K Alexiou, M Laule, R Becker, K Schror, G Baumann, F Brunner, K Stangl: Stimulation of pulmonary big endothelin-1 and endothelin-1 by antithrombin III: a rationale for combined application of antithrombin III and endothelin antagonists in sepsis-related acute respiratory distress syndrome? Crit Care Med28 (2000) 2445Search in Google Scholar
4 Figueras-Aloy J, L Gómez, JM Rodríguez-Miguélez, Y Jordán, MD Salvia, W Jiménez, X Carbonell-Estrany: Plasma nitrite–nitrate and endothelin-1 concentrations in neonatal sepsis. Acta Paediatr92 (2003) 582Search in Google Scholar
5 Fujii Y, S Magder, P Cernacek, P Goldberg, Y Guop, SN Hussain: Endothelin receptor blockade attenuates lipopolysaccharide-induced pulmonary nitric oxide production. Am J Respir Crit Care Med161 (2000) 982Search in Google Scholar
6 Hageman JR, MS Caplan: An introduction to the structure and function of inflammatory mediators for clinicians. Clin Perinatol22 (1995) 251Search in Google Scholar
7 Imai T, Y Hirata, T Emori, M Yanagisawa, T Masaki, F Marumo: Induction of endothelin-1 gene by angiotensin and vasopressin in endothelial cells. Hypertension19 (1992) 753Search in Google Scholar
8 Kohan DE: Role of endothelin and tumour necrosis factor in the renal response to sepsis. Nephrol Dial Transplant9 (1994) 73Search in Google Scholar
9 Marsden PA, BM Brenner: Transcriptional regulation of the endothelin gene by TNF alpha. Am J Physiol262 (1992) C85410.1152/ajpcell.1992.262.4.C854Search in Google Scholar PubMed
10 McMillen MA, ME Cunningham: Origin of endothelin in sepsis. Crit Care Med24 (1996) 721Search in Google Scholar
11 McMillen MA, ME Cunningham: Roles for endothelins in shock. Shock6 (1996) 383Search in Google Scholar
12 Miyauchi T, T Masaki: Pathophysiology of endothelin in the cardiovascular system. Annu Rev Physiol61 (1999) 391Search in Google Scholar
13 Poo JL, W Jiménez, RM Muñoz, M Bosch-Marcé, N Bordas, M Morales-Ruiz, et al.: Chronic blockade of endothelin receptors in cirrhotic rats: hepatic and hemodynamic effects. Gastroenterology116 (1999) 161Search in Google Scholar
14 Richardson DK, JD Corcoran, GJ Escobar, SK Lee, for The Canadian NICU Network, The Kaiser Permanente Neonatal Minimum Data Set Wide Area Network, and The SNAP-II Study Group: SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr138 (2001) 92Search in Google Scholar
15 Rosenberg AA, J Kennaugh, SL Koppenhafer, M Loomis, BA Chatfield, SH Abman: Elevated immunoreactive endothelin-1 levels in newborn infants with persistent pulmonary hypertension. J Pediatr123 (1993) 109Search in Google Scholar
16 Sharma AC, SJ Motew, S Farias, KJ Alden, HB Bosmann, WR Law, et al.: Sepsis alters myocardial and plasma concentrations of endothelin and nitric oxide in rats. J Mol Cell Cardiol29 (1997) 1469Search in Google Scholar
17 Weitzberg E, A Hemsen, A Rudehill, A Modin, M Wanecek, JM Lungberg: Bosentan-improved cardiopulmonary vascular performance and increased plasma levels of endothelin-1 in porcine endotoxin shock. Br J Pharmacol118 (1996) 617Search in Google Scholar
© Walter de Gruyter
Articles in the same Issue
- Author Index
- Subject Index
- Contents
- Difficult delivery of the impacted fetal head during cesarean section: intraoperative disengagement dystocia
- Breech presenting twin A: is vaginal delivery safe?
- Maternal serum interleukin-1β, -6 and -8 levels and potential determinants in pregnancy and peripartum
- Comparison between HELLP syndrome, chronic hypertension, and superimposed preeclampsia on chronic hypertension without HELLP syndrome
- Fetal scalp pH and ST analysis of the fetal ECG as an adjunct to CTG. A multi-center, observational study
- Effects of nitric oxide and prostacyclin on hemodynamic response by big endothelin-1 in near term fetal sheep
- Strategy for management of newborns with cervical teratoma
- Predicting neonatal outcomes: birthweight, body mass index or ponderal index?
- Markers of platelets activation, CD 62P and soluble P-selectin in healthy term neonates
- Detection of parvovirus B19, cytomegalovirus and enterovirus infections in cases of intrauterine fetal death
- Plasma endothelin-1 and clinical manifestations of neonatal sepsis
- Noncompaction of the left ventricular myocardium diagnosed in pregnant woman and neonate
- Ventricular bigeminy misdiagnosed as fetal bradycardia by cardiotocography – the value of non-invasive fetal electrocardiography
- Prolonged fetal bradycardia as the presenting clinical sign in Streptococcus agalactiae chorioamnionitis
- Changes of blood pressure and heart rate variability precede a grand mal seizure in a pregnant woman
- Myocardial infarction in early pregnancy
- The baby and the bathwater – a comment
- Reply to the opinion paper “The baby or the bathwater: which one should be discarded?”
Articles in the same Issue
- Author Index
- Subject Index
- Contents
- Difficult delivery of the impacted fetal head during cesarean section: intraoperative disengagement dystocia
- Breech presenting twin A: is vaginal delivery safe?
- Maternal serum interleukin-1β, -6 and -8 levels and potential determinants in pregnancy and peripartum
- Comparison between HELLP syndrome, chronic hypertension, and superimposed preeclampsia on chronic hypertension without HELLP syndrome
- Fetal scalp pH and ST analysis of the fetal ECG as an adjunct to CTG. A multi-center, observational study
- Effects of nitric oxide and prostacyclin on hemodynamic response by big endothelin-1 in near term fetal sheep
- Strategy for management of newborns with cervical teratoma
- Predicting neonatal outcomes: birthweight, body mass index or ponderal index?
- Markers of platelets activation, CD 62P and soluble P-selectin in healthy term neonates
- Detection of parvovirus B19, cytomegalovirus and enterovirus infections in cases of intrauterine fetal death
- Plasma endothelin-1 and clinical manifestations of neonatal sepsis
- Noncompaction of the left ventricular myocardium diagnosed in pregnant woman and neonate
- Ventricular bigeminy misdiagnosed as fetal bradycardia by cardiotocography – the value of non-invasive fetal electrocardiography
- Prolonged fetal bradycardia as the presenting clinical sign in Streptococcus agalactiae chorioamnionitis
- Changes of blood pressure and heart rate variability precede a grand mal seizure in a pregnant woman
- Myocardial infarction in early pregnancy
- The baby and the bathwater – a comment
- Reply to the opinion paper “The baby or the bathwater: which one should be discarded?”
