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The neuroendocrine stress response and severity of acute respiratory syncytial virus bronchiolitis in infancy

  • Neonatal and Pediatric Intensive Care
  • Published:
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Abstract

Objective

Neuroendocrine hormones have profound effects on the immune system. The immune response is a major factor in the pathogenesis of acute respiratory syncytial virus (RSV) infection. We hypothesised that there is a relationship between the neuroendocrine response in acute RSV infection, the severity of illness, and the degree of lymphopenia.

Design

Prospective, non-randomised cohort study of infants hospitalised for RSV infection requiring mechanical ventilation or managed conservatively. The study assessed the effect of age, gender, birth gestation, and severity of illness on stress hormone profile and its relationship to lymphocyte count.

Setting

Regional Paediatric Intensive Care Unit (PICU) and children’s wards.

Patients

Thirty-two consecutive infants with RSV infection were enrolled, of which thirteen were mechanically ventilated on PICU (study subjects) and nineteen treated on the ward (comparison group). Twenty-three children (72%) returned for follow-up.

Measurements and main results

A specific neuroendocrine profile was found in PICU patients compared to ward patients (Wilks Lambda = 0.36, F = 9.05, P =.03). PICU patients had significantly higher prolactin and growth hormone, and significantly lower leptin and IGF-1. Cortisol levels were the same. PICU patients were more lymphopenic compared to ward patients (P =.0001). On multiple regression analysis, prolactin and leptin levels accounted for 57% of the variation in lymphocyte count.

Conclusions

Whereas the effect of intensive care (mechanical ventilation and medication) could not be controlled for, our results suggest that there is an association between the neuroendocrine hormone response, severity of illness and degree of lymphopenia.

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Authors and Affiliations

  1. Department of Paediatrics, Addenbrooke’s Hospital, University of Cambridge, Hills Road, Box 181, Cambridge, CB2 2QQ, UK

    Robert C. Tasker, Michael F. E. Roe, Deborah K. White, Robert I. Ross-Russell & D. Roddy O’Donnell

  2. Department of Haematology, Addenbrooke’s Hospital, Cambridge, UK

    David M. Bloxham

Authors
  1. Robert C. Tasker
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  2. Michael F. E. Roe
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  3. David M. Bloxham
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  4. Deborah K. White
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  5. Robert I. Ross-Russell
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  6. D. Roddy O’Donnell
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Corresponding author

Correspondence to D. Roddy O’Donnell.

Additional information

Support: H.C. Roscoe Fellowship, British Medical Association, and Addenbrooke’s Paediatric Intensive Care Research Fund

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Tasker, R.C., Roe, M.F.E., Bloxham, D.M. et al. The neuroendocrine stress response and severity of acute respiratory syncytial virus bronchiolitis in infancy. Intensive Care Med 30, 2257–2262 (2004). https://doi.org/10.1007/s00134-004-2470-7

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  • DOI: https://doi.org/10.1007/s00134-004-2470-7

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