EICOSANOIDS DECREASE WITH SUCCESSFUL EXTRACORPOREAL MEMBRANE-OXYGENATION THERAPY IN NEONATAL PULMONARY-HYPERTENSION

Elevated concentrations of eicosanoids have been reported in bronchoal veolar ravage fluid (BALF) and blood of infants with persistent pulmon ary hypertension (PPHN), thereby indicating their potential role in it s pathophysiology. Extracorporeal membrane oxygenation (ECMO) has impr oved the outcome in selected infants with PPHN. We hypothesized that E CMO, by alleviating lung injury, would be associated with decreased ei cosanoid production and clinical improvement. Twenty-two newborns with PPHN treated with either ECMO or conventional means were studied. Con centrations of TxB(2), 6-keto-PGF(1 alpha), PGD(2), PGE(2), LTB(4), an d LTE(4) were serially measured in BALF. Elevated concentrations of al l eicosanoids measured were observed in all infants with PPHN at the i nitiation of ECMO. Eicosanoid concentrations decreased in all infants with a good clinical outcome after ECMO, but they remained elevated in those with a poor outcome. In patients with less severe PPHN, not req uiring ECMO, lower concentrations of eicosanoids were observed at init iation of therapy. Eicosanoid levels increased or did not change over the course of conventional treatment. We conclude that eicosanoids are present in high concentrations in infants with PPHN. Iatrogenic facto rs, including oxygen and barotrauma, appear to correlate with their co ncentrations. Removal of these factors is associated with decreased pr oduction of mediators and clinical improvement.