| Objective:With the neonatal intensive care continuously improve the survival rate of neonatal respiratory distress syndrome(NRDS) patients is getting higher and higher. In the treatment of neonatal respiratory distress syndrome, the mechanical ventilation help to improving ventilation, alveolar in proper control. But ventilator-induced lung injury and ventilator-associated pneumonia (VAP)also significantly increased.VAP has some epidemiological characteristics, In the different NICU ventilator-associated pneumonia incidence varied widely, bacteria and bacterial resistance is different.Patients with VAP will not only increase with oxygen, duration of hospitalization, increased cost of treatment, but the prognosis of patients have adverse impact on children with increased mortality. Immunomodulator disorder is the development of pathological processes in ventilator-associated pneumonia. Helper T cells (Th) for the body of the specific immunization and non-specific immunity, as well as cellular immunity and humoral immunity have an important role.Based on the different cytokines, helper T cells can be divided into two types: TH1 and TH2 cells. TH1/TH2, through its secretion of cytokines negative feedback mechanism to regulate each other's mutual differentiation and proliferation. Taken mutual inhibition, in a dynamic equilibrium. IL-4, IL-13 is secreted primarily by TH2 cells.By monitoring in vivo IL-4, IL-13 concentration can indirectly know Th1/Th2 balance, help understanding the pathogenesis of pulmonary inflammation, the development process for clinical implementation of immune intervention and to help adjust Th1/Th2 balance. IL-4, IL-13 in asthma disease also play an important role. Understanding of the development process in such Children's lung diseases,linking the neonatal period of ventilator-associated lung injury to the childhood asthma, will help exploring the pathogenesis of asthma in children infant diseases origin, thereby providing for new ideas for the prevention and treatment of asthma.Methods:The subjects were patients in Hebei Children's Hospital Neonatal Branch since February 2007 to December 2007, Consistent with the diagnosis of neonatal respiratory distress syndrome standards,within 24 hours after birth hospitalized for endotracheal intubation and mechanical ventilation time > 48-hour children. Except major respiratory system, cardiovascular system, nervous system and respiratory tract infections in children with deformity, and their families do not agree to participate in the trial of the children.Comply with the conditions of a total of 68 children, of which occurred ventilator-associated pneumonia (VAP) in 37 children, and did not occur VAP in 31 children. They Were defined as group A (in VAP) and group B (not occurring VAP). All selected patients are hospitalized of their time of birth statistics, gender, mode of delivery, gestational age, weight, SNPPE-II score, pulmonary surfactant (PS) the application of hormone use, complications, duration of mechanical ventilation, oxygen, hospital time and hospitalization costs. All patients were selected for routine care and treatment, Each selected patients within 0-6 hours collecting bronchial secretions do a culture and chest X-ray taken every 1-2 days review chest X-ray. 48-72 hours for mechanical ventilation collecting airway secretions do sputum culture and sensitivity test. Ventilator-associated pneumonia diagnosis criterion-referenced Chinese Medical Association developed by the Respiratory Diseases Branch of the "hospital-acquired pneumonia diagnosis and treatment guidelines": MV 48h after the use of X-ray examination revealed: pulmonary infiltrates, or the emergence of new invasive shadow investigation of the lungs can be heard and wet rales, along with one of the following conditions: WBC> 10×109 / L, in the temperature above 37.5℃, respiratory a purulent secretions, bronchial secretions from the isolated pathogens or new pathogens. All the selected patients immediately take a bronchoalveolar lavage fluid and blood after giving tracheal intubation. Second based in the mechanical ventilation for 48 hours, Third based: Group A in the 72-96 hours of mechanical ventilation, group B at the same time or when based extubation. Each patient were collecting bronchoalveolar lavage fluid and serum three times. With the 3000r/min centrifugalization 10 minutes, blood serum were accepted and set spare to -20℃refrigerator preservation. Experimental testing of the following indicators: serum levels of IL-4, IL-13 concentrations, bronchoalveolar lavage fluid of IL-4, IL-13 concentrations. All of the tests were measured according to the manufacture's instructions. The statistical analysis was done by SPSS 10.0 software.Results:1 Included in the study a total of 68 children with neonatal respiratory distress syndrome. In which 37 ventilator-associated pneumonia (group A) and 31 patients with no ventilator-associated pneumonia (group B). Incidence is 54.4%.2 compared the sex ratio,the mode of delivery,the application of PS,application of steroids between the two groups, there was no significant difference (P> 0.05).3 Ages between the two groups, gestational age, weight, compared SNPPE-II score There was no significant difference (P> 0.05).4 Children with group A mechanical ventilation, oxygen exposure time, the length of stay, hospital costs significantly greater than with group B, the statistical analysis of P <0.05, a significant difference.5 Comparison of complications and prognosis between the two groups: four cases of death in group A, one case of death in group B, but the statistical test p> 0.05, with no statistical significance. Gas leakage, the incidence of intracranial hemorrhage were not statistically significant (p> 0.05).6 Ventilator-associated pneumonia group (group A) of the pathogens and drug sensitivity analysis: Sputum pui results mainly: Klebsiella pneumoniae 17 cases (45.9%), Pseudomonas aeruginosa seven cases (18.9%), drug sensitivity test: meropenem, ciprofloxacin, amikacin Most sensitive. Some of cefoperazone / sulbactam sensitive to ceftriaxone and piperacillin most resistance.7 The comparison of IL-4, IL-13 concentrations between Group A and B: The patients at the first time point between the two groups showed no significant difference (P> 0.05), the second time points compared between the two groups no significant difference too (P> 0.05), between the first and the second points there is no significant difference between the two groups (P> 0.05), but compared the two groups in the third time point :IL-4, IL-13 concentrations was higher in group A than in group B, There was a statistically significant difference (P <0.05). And the third time point also increased significantly compared to the first two time pionts ,through statistical analysis There was a significant difference(P <0.05).Conclusion : 1 The ventilation-associated pneumonia, increase duration of mechanical ventilation, oxygen, hospital costs and length of stay.This has an adverse impact on the children themselves,their families and the community. 2 In this study, the incidence of ventilator-associated pneumonia was not related to the age,weight and the pulmonary surfactant application material. 3 Ventilator-associated pneumonia group (group A) of the pathogens and drug sensitivity analysis: Sputum pui results mainly: Klebsiella pneumoniae 17 cases (45.9%), Pseudomonas aeruginosa seven cases (18.9%), drug sensitivity test: meropenem, ciprofloxacin, amikacin Most sensitive. Some of cefoperazone / sulbactam sensitive to ceftriaxone and piperacillin most resistance. 4 The IL-4 and IL-13 concentrations in blood and bronchoalveolar lavage fluid of the children with ventilator-associated pneumonia increased. This Play the role of getting down Inflammation. The Th1/Th2 balance are more and more inclined to Th2, This is an important factor of the promotion or aggravating of diseases. By monitoring the IL-4, IL-13 concentration in vivo can indirectly know the Th1/Th2 balance, help understanding the pathogenesis of pulmonary inflammation.Therefore, to meet the requirements of clinical immune intervention, adjustment Th1/Th2 balance of the mechanical ventilation patients.
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