ACTIVATION OF THE KALLIKREIN‐KININ SYSTEM IN PREMATURE INFANTS WITH RESPIRATORY DISTRESS SYNDROME (RDS)

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Abstract
Plasma prekallikrein levels, kallikrein activity and antikallikrein levels were investigated in 9 premature [human] infants with respiratory distress syndrome (RDS) and 6 premature infants without. Plasma prekallikrein and kallikrein were determined with a chromogenic substrate measuring amidolytic activity. Antikallikrein was measured with a functional assay. In infants with severe RDS, prekallikrein levels were significantly reduced (median 58% of initial values (P < 0.01) .apprx. 48 h after onset of symptoms. In infants with moderate RDS prekallikrein level was reduced less, while in babies without RDS there were no significant changes in prekallikrein levels the first 5-7 days of life. Antikallikrein levels did not change significantly in any babies. The kallikrein-kinin system might be involved in RDS. This could explain several features of this syndrome such as hypotension and edema. Homeostatic functions are altered in this disease, suggesting that other cascade systems such as the coagulation, fibrinolytic and complement system, may also be involved. Trauma might be a significant pathogenetic factor for development of this syndrome. RDS is not simply a biochemical disease with lack of surfactant as the only pathogenetic factor.