The role of inflammation in the development of chronic lung disease in neonates

Chronic lung disease (CLD) has been associated with chorioamnionitis and up per respiratory tract colonisation with Ureaplasma urealyticum. The aim of this review is to describe the increasing evidence that inflammation plays a critical role in the early stages of CLD of the neonate. Ongoing lung dam age in the premature infant may be caused by failure to downregulate and co ntrol this inflammatory response. Tumour necrosis factor alpha (TNF-alpha), interleukin-6 (IL-6) and IL-8 are important pro-inflammatory cytokines of which IL-8 is an important chemotactic factor in the lung. Data suggest tha t preterm newborns with lung inflammation may be unable to activate the ant iinflammatory cytokine IL-10. Therefore, early post-natal anti-inflammatory therapy could help in preventing development of CLD. Prophylactic dexameth asone therapy cannot yet be recommended. There are a number of potential in teractions between surfactant and cytokine effects on the preterm lung whic h have not been evaluated. Surfactant protein A may be an important modulat or of the immune response to lung injury. The role of high-frequency ventil ation in the prevention of CLD still remains unclear. Conclusion Many aspects of the pathogenesis of the inflammatory response in the development of chronic lung disease remain to be elucidated. Further r esearch to identify preterm infants at highest risk for the development of this multifactorial and complex disease is needed.