The role of inflammation and clotting in the development of neonatal respiratory distress syndrome

Neonatal Respiratory Distress Syndrome (neonatal RDS) occurs in preterm infants, due to structural immaturity of the lungs and immaturity of the pulmonary surfactant metabolism, resulting in surfactant deficiency and surfactant dysfunction. Apart from these factors there is increasing evidence that inflammation and clotting contributed to the progression of this disease. However most authors describe abnormalities in broncho-alveolar lavage fluid and plasma that can be found on various days after birth, probably more reflecting the role of the inflammatory reaction in the progression from neonatal RDS to bronchopulmonary dysplasia than the role of inflammation in neonatal RDS itself. The aim of this thesis was to elucidate the role of local as well as systemic activation of the inflammatory reaction and clotting in the development and the severity of neonatal RDS in the period immediately after delivery. We intended to develop an animal model to investigate these systems and their mutual interactions. In this model we planned to compare the impact of different ventilatory modes (conventional ventilation and high frequency oscillatory ventilation) and of already established therapies as endotracheal surfactant administration and antenatal glucocorticoid administration on activation of the inflammatory reaction