478: Imaging before 24 weeks gestation can predict neonatal respiratory morbidity in pregnancies complicated by fetal lung masses

Abstract Background: To develop a non-invasive method for the prenatal prediction of neonatal respiratory morbidity (NRM) by a novel radiomics method based on imbalanced few-shot fetal lung ultrasound images.Methods: A total of 210 fetal lung ultrasound images were enrolled in this study, including 159 normal newborns and 51 NRM newborns. Fetal lungs were delineated as the region of interest (ROI), where radiomics features were designed and extracted. Integrating radiomics features selected and two clinical features, including gestational age (GA) and gestational diabetes mellitus (GDM), the prediction model was developed and evaluated. The modelling methods used were data augmentation, cost-sensitive learning, and ensemble learning. Furthermore, two methods, which embed data balancing into ensemble learning, were employed to address the problems of imbalance and few-shot simultaneously.Results: Our model achieved sensitivity values of 0.82, specificity values of 0.84, accuracy values of 0.84 and area under the curve values of 0.87 in the test set. The radiomics features extracted from the ROIs at different locations within the lung region achieved similar classification performance outcomes.Conclusion: The feature set we designed can efficiently and robustly describe fetal lungs for NRM prediction. RUSBoost shows excellent performance compared to state-of-the-art classifiers on the imbalanced few-shot dataset. The diagnostic efficacy of the model we developed is similar to that of several previous reports of amniocentesis and can serve as a non-invasive, precise evaluation tool for NRM prediction.

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Efficacy and Safety of Corticosteroids’ Administration for Pulmonary Immaturity in Anticipated Preterm Delivery

Current Pharmaceutical Design ◽

10.2174/1381612826666201207102910 ◽

2020 ◽

Vol 26 ◽

Author(s):

Themistoklis Dagklis ◽

Ioannis Tsakiridis ◽

Georgios Papazisis ◽

Apostolos Athanasiadis

Keyword(s):

Preterm Delivery ◽

Neonatal Morbidity ◽

Fetal Lung ◽

Respiratory Morbidity ◽

Efficacy And Safety ◽

Antenatal Corticosteroids ◽

Lung Maturation ◽

Early Neonatal Mortality ◽

Elective Cesarean ◽

Fetal Lung Maturation

: Preterm delivery represents the major cause of neonatal morbidity and mortality. Respiratory morbidity is the primary cause of early neonatal mortality and disability. The administration of antenatal corticosteroids, in cases of imminent preterm delivery, can enhance fetal lung maturation and reduce the incidence of respiratory distress syndrome, leading to improved neonatal outcomes. Hence, for those cases, a single course of antenatal corticosteroids from 24 up to 34 gestational weeks should be offered. Betamethasone and dexamethasone are the most widely used drugs, with similar effectiveness and a recommended dosage of 24mg in divided doses, over a 24-hour period. However, there is an ongoing debate regarding the gestational age of administration. Some obstetric societies recommend their administration even at 22 weeks of gestation. Conflicting is also their usefulness in late preterm cases (between 34 and 37 weeks) or in cases of elective cesarean delivery at term. The use of repeated courses of corticosteroids may be considered in specific cases, however, concerns on the long-term outcomes of repeated courses beyond 34 gestational weeks have been raised. The scope of this narrative review was to synthesize available evidence on efficacy and safety of corticosteroids administration during the antenatal period for pulmonary immaturity in cases of anticipated preterm delivery.

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The impact of perinatal nicotine exposure on fetal lung development and subsequent respiratory morbidity

Birth Defects Research ◽

10.1002/bdr2.1595 ◽

2019 ◽

Vol 111 (17) ◽

pp. 1270-1283 ◽

Cited By ~ 3

Author(s):

Katherine M. Kuniyoshi ◽

Virender K. Rehan

Keyword(s):

Lung Development ◽

Fetal Lung ◽

Respiratory Morbidity ◽

Nicotine Exposure ◽

Fetal Lung Development ◽

The Impact

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The risk of neonatal respiratory morbidity according to the etiology of late preterm delivery

Journal of Perinatal Medicine ◽

10.1515/jpm-2015-0191 ◽

2017 ◽

Vol 45 (1) ◽

Author(s):

Sung Ae Kim ◽

Seung Mi Lee ◽

Byoung Jae Kim ◽

Chan-Wook Park ◽

Joong Shin Park ◽

...

Keyword(s):

Preterm Birth ◽

Preterm Delivery ◽

Fetal Lung ◽

Late Preterm ◽

Respiratory Morbidity ◽

Preterm Neonates ◽

Lung Maturation ◽

Study Population ◽

Fetal Lung Maturation ◽

Fetal Compromise

AbstractObjective:The risk of neonatal respiratory morbidity between indicated deliveries vs. spontaneous deliveries has not been consistent in previous studies, in spite of the traditional belief that chronic intrauterine stress might have protective effect on fetal lung maturation. We hypothesized that the heterogeneous etiology of indicated preterm delivery may obscure the relationship between the etiologies of preterm birth and neonatal respiratory morbidity. To address this issue, we divided the indicated preterm birth (PTB) into medically-indicated (without fetal compromise) PTB and maternal/fetal-indicated PTB, and compared the neonatal respiratory morbidity according to the etiology of late PTB.Study design:Neonatal respiratory morbidities were examined in neonates who were delivered between 34+0 and 36+6 weeks of gestation according to the etiology of PTB: 1) medically-indicated PTB (but without fetal compromise), 2) maternal/fetal-indicated PTB, or 3) spontaneous PTB such as preterm labor or preterm premature rupture of membranes.Results:A total of 710 late preterm neonates were included in the study population, including 31 cases of medically-indicated PTB, 202 cases of maternal/fetal-indicated PTB, and 477 cases of spontaneous PTB. The rate of composite respiratory morbidity in cases of medically-indicated PTB is higher than both maternal/fetal-indicated PTB and spontaneous PTB (19% in medically-indicated PTB, 6% in maternal/fetal-indicated PTB, and 7% in spontaneous PTB). This difference between medically-indicated PTB and maternal/fetal-indicated PTB remained significant after adjustment for confounding variables.Conclusion:The medically-indicated PTB is associated with highest risk of neonatal respiratory morbidity in late PTB.

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Ventilation-induced lung injury is not exacerbated by growth restriction in preterm lambs

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.00328.2015 ◽

2016 ◽

Vol 310 (3) ◽

pp. L213-L223 ◽

Cited By ~ 12

Author(s):

Beth J. Allison ◽

Stuart B. Hooper ◽

Elise Coia ◽

Valerie A. Zahra ◽

Graham Jenkin ◽

...

Keyword(s):

Lung Injury ◽

Lung Inflammation ◽

Morphological Changes ◽

Weight Ratio ◽

Fetal Lung ◽

Growth Restriction ◽

Respiratory Morbidity ◽

Vascular Structure ◽

Fetal Sheep ◽

Ventilation Induced Lung Injury

Intrauterine growth restriction (IUGR) and preterm birth are frequent comorbidities and, combined, increase the risk of adverse respiratory outcomes compared with that in appropriately grown (AG) infants. Potential underlying reasons for this increased respiratory morbidity in IUGR infants compared with AG infants include altered fetal lung development, fetal lung inflammation, increased respiratory requirements, and/or increased ventilation-induced lung injury. IUGR was surgically induced in preterm fetal sheep (0.7 gestation) by ligation of a single umbilical artery. Four weeks later, preterm lambs were euthanized at delivery or delivered and ventilated for 2 h before euthanasia. Ventilator requirements, lung inflammation, early markers of lung injury, and morphological changes in lung parenchymal and vascular structure and surfactant composition were analyzed. IUGR preterm lambs weighed 30% less than AG preterm lambs, with increased brain-to-body weight ratio, indicating brain sparing. IUGR did not induce lung inflammation or injury or alter lung parenchymal and vascular structure compared with AG fetuses. IUGR and AG lambs had similar oxygenation and respiratory requirements after birth and had significant, but similar, increases in proinflammatory cytokine expression, lung injury markers, gene expression, and surfactant phosphatidylcholine species compared with unventilated controls. IUGR does not induce pulmonary structural changes in our model. Furthermore, IUGR and AG preterm lambs have similar ventilator requirements in the immediate postnatal period. This study suggests that increased morbidity and mortality in IUGR infants is not due to altered lung tissue or vascular structure, or to an altered response to early ventilation.

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Prenatal prediction of neonatal respiratory morbidity: a radiomics method based on imbalanced few-shot fetal lung ultrasound images

BMC Medical Imaging ◽

10.1186/s12880-021-00731-z ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Jing Jiao ◽

Yanran Du ◽

Xiaokang Li ◽

Yi Guo ◽

Yunyun Ren ◽

...

Keyword(s):

Ensemble Learning ◽

Data Augmentation ◽

Lung Ultrasound ◽

Fetal Lung ◽

Performance Outcomes ◽

Respiratory Morbidity ◽

Ultrasound Images ◽

Evaluation Tool ◽

Non Invasive ◽

Fetal Lungs

Abstract Background To develop a non-invasive method for the prenatal prediction of neonatal respiratory morbidity (NRM) by a novel radiomics method based on imbalanced few-shot fetal lung ultrasound images. Methods A total of 210 fetal lung ultrasound images were enrolled in this study, including 159 normal newborns and 51 NRM newborns. Fetal lungs were delineated as the region of interest (ROI), where radiomics features were designed and extracted. Integrating radiomics features selected and two clinical features, including gestational age and gestational diabetes mellitus, the prediction model was developed and evaluated. The modelling methods used were data augmentation, cost-sensitive learning, and ensemble learning. Furthermore, two methods, which embed data balancing into ensemble learning, were employed to address the problems of imbalance and few-shot simultaneously. Results Our model achieved sensitivity values of 0.82, specificity values of 0.84, balanced accuracy values of 0.83 and area under the curve values of 0.87 in the test set. The radiomics features extracted from the ROIs at different locations within the lung region achieved similar classification performance outcomes. Conclusion The feature set we designed can efficiently and robustly describe fetal lungs for NRM prediction. RUSBoost shows excellent performance compared to state-of-the-art classifiers on the imbalanced few-shot dataset. The diagnostic efficacy of the model we developed is similar to that of several previous reports of amniocentesis and can serve as a non-invasive, precise evaluation tool for NRM prediction.

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New Ultrastructural Observations on Injury and Regeneration of Cilia in Mammalian Conducting Airway Epithelium

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100099544 ◽

1981 ◽

Vol 39 ◽

pp. 624-625

Author(s):

J.L. Carson ◽

A.M. Collier

Keyword(s):

Respiratory Tract ◽

Airway Epithelium ◽

Defense Mechanisms ◽

Normal Growth ◽

Fetal Lung ◽

Secretory Cells ◽

Airway Epithelial ◽

Ciliated Cells ◽

Conducting Airway ◽

Conducting Airways

The ciliated cells lining the conducting airways of mammals are integral to the defense mechanisms of the respiratory tract, functioning in coordination with secretory cells in the removal of inhaled and cellular debris. The effects of various infectious and toxic agents on the structure and function of airway epithelial cell cilia have been studied in our laboratory, both of which have been shown to affect ciliary ultrastructure.These observations have led to questions about ciliary regeneration as well as the possible induction of ciliogenesis in response to cellular injury. Classical models of ciliogenesis in the conducting airway epithelium of the mammalian respiratory tract have been based primarily on observations of the developing fetal lung. These observations provide a plausible explanation for the embryological generation of ciliary beds lining the conducting airways but do little to account for subsequent differentiation of ciliated cells and ciliogenesis during normal growth and development.

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