Prostaglandin E₂ Mediates Cardiorespiratory Disturbances during Infection in Neonates

Objective To determine whether infection, with associated eicosanoid release, is a main cause of respiratory disruption in neonates, by measuring levels of prostaglandin E₂ (PGE₂) and its metabolite (PGEM) in cerebrospinal fluid (CSF). Study design Of 59 eligible infants, 25 preterm infants (mean gestational age, 28 ± 0.5 weeks) and 22 full-term infants (mean gestational age, 40 ± 0.5 weeks) from a level 3 neonatal intensive care unit and the general maternity neonatal ward were enrolled prospectively. Infants with a condition that can cause secondary apnea were excluded. Cardiorespiratory disturbances, such as apnea, bradycardia, and desaturation (ABD) events, were quantified. All infants were subjected to standard laboratory analysis of blood and CSF concentrations of biomarkers, including PGE₂ and PGEM, within 24 hours of lumbar puncture, which were correlated with ABD events and culture-verified infections. Results PGEM levels were highest in infants with culture-verified sepsis and meningitis (P <.01). In infants without culture-verified bacterial infections, PGEM levels were higher in preterm infants compared with term infants (P <.05). The numbers of desaturation events and apnea events in neonates were positively associated with PGE₂ levels in CSF (P <.05). Conclusion PGE₂ and PGEM are rapidly elevated in CSF during an infectious event and may explain cardiorespiratory disturbances, which are the major presenting symptoms of neonatal infections. PGE₂ and PGEM are released during bacterial infections and could serve as biomarkers for sepsis and autonomic dysfunction in neonates.