N-TERMINAL PROPEPTIDE OF TYPE-III COLLAGEN IN TRACHEAL FLUID AND SERUM IN PRETERM INFANTS AT RISK FOR BRONCHOPULMONARY DYSPLASIA

Bronchopulmonary dysplasia (BPD) is a common pulmonary complication in preterm infants that leads to fibrosis of the bronchoalveolar walls and often to severe clinical consequences. Type III collagen is deposited early in progressive fibrosis. Because the N-terminal propeptide of type III collagen (PIIINP), a by-product of type III collagen synthesis, reflects the degree of pulmonary fibrosis in adults, we hypothesized that PIIINP in tracheal aspirates and/or serum may be a useful early marker of developing BPD in neonates. We serially measured PIIINP in tracheal fluid and serum samples during the first weeks of life in 41 consecutive respirator-treated preterm infants (mean birth weight 1067 g, mean gestational age 28.3 wk). Eight of the infants died and 22 infants fulfilled the criteria for BPD at age 28 d. The mean level of PIIINP decreased with advancing postnatal age in tracheal fluid but not in serum. The mean tracheal fluid PIIINP during d 1 and 2 of life, respectively, was 175 and 200 ng/mg protein in infants who were still in a respirator at age 28 d (n = 13), 122 and 97 ng/mg protein in those who were weaned earlier (n = 20), and 50 and 30 ng/mg protein in those who died before age 28 d (n = 8). These differences are not statistically significant, and the variability, of the values was large. The PIIINP concentrations in tracheal aspirates of infants subsequently developing BPD did not differ from those without BPD. Neither did the levels correlate with the degree of BPD or radiologically defined fibrosis. In contrast to the findings in tracheal fluid, the serum PIIINP levels in infants subsequently developing BPD were significantly higher (p = 0.01) than those in infants without BPD, the respective mean (9%) confidence intervals) concentrations being 788 (range 519-1057) and 256 (range 171-341) ng/mL. We conclude that serum PIIINP should be further evaluated as an early marker of BPD, whereas tracheal fluid levels are useless for this purpose.