FETAL LUNG MATURATION IN TOXEMIA AND ŒSTROGEN THERAPY IN MANAGEMENT OF RESPIRATORY DISTRESS SYNDROME

Fetal growth restriction in singletons has been shown to enhance fetal lung maturation and reduce the risk of respiratory distress syndrome due to increased endogenous steroid production. However, data on lung maturation in growth-discordant monochorionic (thus, identical) twins are lacking. Our objective was to compare the risk of severe neonatal morbidity between the larger and the smaller twin in monochorionic twins with birth weight discordance (BWD). We included in the study all consecutive monochorionic diamniotic pregnancies with severe BWD (≥25%) and two live-born twins delivered at our center (n = 47 twin pairs). We compared the incidence of neonatal morbidity, particularly respiratory distress syndrome (RDS), and cerebral lesions between the larger and the smaller co-twin. The incidence of severe neonatal morbidity in the larger and smaller twin was 38% (18/47) and 19% (9/47), respectively (odds ratio (OR) 2.66, 95% confidence interval (CI) 0.94–7.44) and was due primarily to the higher incidence of RDS, 32% (15/47) and 6% (3/47), respectively (OR 6.88, 95% CI 1.66–32.83). In conclusion, this study shows that the larger twin in monochorionic twin pairs with BWD is at increased risk of severe neonatal morbidity, particularly RDS, compared to the smaller twin.

Download Full-text

The Relationship between Maternal Hypertensive Disease of Pregnancy and the Incidence of Idiopathic Respiratory Distress Syndrome

PEDIATRICS ◽

10.1542/peds.65.4.735 ◽

1980 ◽

Vol 65 (4) ◽

pp. 735-739 ◽

Cited By ~ 1

Author(s):

Jing Ja Yoon ◽

Schuyler Kohl ◽

Rita G. Harper

Keyword(s):

Mortality Rate ◽

Respiratory Distress Syndrome ◽

Gestational Age ◽

Distress Syndrome ◽

Fetal Lung ◽

Hypertensive Disease ◽

Lung Maturation ◽

Idiopathic Respiratory Distress Syndrome ◽

Fetal Lung Maturation ◽

The Relationship

The relationship between maternal hypertensive disease of pregnancy (HDOP) and idiopathic respiratory distress syndrome (IRDS) was analyzed in 2,105 premature infants weighing between 1,000 and 2,199 gm and born between January 1968 and December 1975 at the Kings County Hospital Center and State University Hospital. HDOP was diagnosed in 250 mothers of 2,105 infants studied. The incidence of IRDS (15.2%) in the HDOP group was significantly lower than the 29.9% in the non-HDOP group (P < .001). In infants whose gestational age was 32 weeks or less, the incidence of IRDS was 26.1% in the HDOP group and 40.8% in the non-HDOP group (P < .01). In infants whose gestational age was 33 weeks or more, the incidence (9.3%) in the HDOP group was significantly lower than the 18.4% in the non-HDOP group (P < .005). The low incidence of IRDS in the HDOP group remained even after eliminating infants with known predisposing and protecting factors from the development of IRDS. The incidence of IRDS was inversely related to the severity of maternal toxemia. The total mortality and mortality with IRDS were not significantly different in both HDOP and non-HDOP groups. When the infants did not develop IRDS, the mortality rate in the HDOP group was significantly higher than that in the non-HDOP group especially in the lower gestational age group. These data suggest that chronic stress accelerates fetal lung maturation and severe chronic stress is even more effective in accelerating fetal lung maturation. When maternal toxemia was severe enough to accelerate the fetal lung maturation, the mortality rate of the infants without IRDS increased.

Download Full-text

A Controlled Trial of Antepartum Glucocorticoid Treatment for Prevention of the Respiratory Distress Syndrome in Premature Infants, by G. C. Liggins, MB, PhD, FRCOG, and R. N. Howie, MB, MRACP, Pediatrics, 1972;50:515–525

PEDIATRICS ◽

10.1542/peds.102.s1.250 ◽

1998 ◽

Vol 102 (Supplement_1) ◽

pp. 250-252

Author(s):

Mary Ellen Avery

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Controlled Trial ◽

Fetal Lung ◽

Hyaline Membrane Disease ◽

Treated Group ◽

Premature Delivery ◽

Glucocorticoid Treatment ◽

Increased Risk

A controlled trial of betamethasone therapy was carried out in 282 mothers in whom premature delivery threatened or was planned before 37 weeks' gestation, in the hope of reducing the incidence of neonatal respiratory distress syndrome by accelerating functional maturation of the fetal lung. A total of 213 mothers were in spontaneous premature labor. When necessary, ethanol or salbutamol infusions were used to delay delivery while steroid or placebo therapy was given. Delay for at least 24 hours was achieved in 77% of the mothers. In these unplanned deliveries, early neonatal mortality was 3.2% in the treated group and 15.0% in the control subjects. There were no deaths with hyaline membrane disease or intraventricular cerebral hemorrhage in infants of mothers who had received betamethasone for at least 24 hours before delivery. The respiratory distress syndrome occurred less often in treated babies (9.0%) than in controls (25.8%), but the difference was confined to babies of <32 weeks' gestation who had been treated for at least 24 hours before delivery (11.8% of the treated babies compared with 69.6% of the control babies). There may be an increased risk of fetal death in pregnancies complicated by severe hypertension–edema–proteinuria syndromes and treated with betamethasone, but no other hazard of steroid therapy was noted. We conclude that this preliminary evidence justifies additional trials, but that additional work is needed before any new routine procedure is established.

Download Full-text

Updates on the Status of Vitamin D as a Risk Factor for Respiratory Distress Syndrome

Advances in Pharmacological Sciences ◽

10.1155/2018/8494816 ◽

2018 ◽

Vol 2018 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Vesara Ardhe Gatera ◽

Rizky Abdulah ◽

Ida Musfiroh ◽

Raden Tina Dewi Judistiani ◽

Budi Setiabudiawan

Keyword(s):

Vitamin D ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Animal Studies ◽

Distress Syndrome ◽

Vitamin D Supplementation ◽

Preterm Neonates ◽

Lung Maturation ◽

Optimal Dosing ◽

Dosing Strategies

To update the guidelines regarding vitamin D status in respiratory distress syndrome, we reviewed recent human and animal studies on the benefits of vitamin D in respiratory distress. We searched PubMed and ProQuest for studies on the use of vitamin D from 2009 to 2017. The common parameters in these studies included the use of lung tissue, phospholipids, blood, and plasma to assess the effects of vitamin D on respiratory syndrome. The metabolized form of vitamin D used in these studies was 1,25(OH)2D3 in animal studies and 25(OH)D in human studies. Vitamin D supplementation decreases the risk of respiratory distress syndrome, improves the quality of life, and is relatively effective and safe for preterm neonates as well as during lung maturation. However, although vitamin D supplementation may offer benefits for respiratory distress syndrome, the optimal dosing strategies for specific types of risk factors in the lungs must be clarified to confirm the therapeutic efficacy.

Download Full-text

Assay of disaturated phosphatidylcholine in amniotic fluid as a test of fetal lung maturity: experience with 2000 analyses.

Clinical Chemistry ◽

10.1093/clinchem/33.9.1648 ◽

1987 ◽

Vol 33 (9) ◽

pp. 1648-1651 ◽

Cited By ~ 13

Author(s):

M Y Tsai ◽

E K Shultz ◽

P P Williams ◽

R Bendel ◽

J Butler ◽

...

Keyword(s):

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Amniotic Fluid ◽

Distress Syndrome ◽

Fetal Lung ◽

Fetal Lung Maturity ◽

Pooled Samples ◽

Lung Maturity ◽

Diabetic Mothers ◽

Length Of Gestation

Abstract We determined concentrations of disaturated phosphatidylcholine (DSPC) in nearly 2000 amniotic fluid samples obtained either transabdominally or as vaginal pools. Here we report our comparison of these DSPC values with the lecithin/sphingomyelin (L/S) ratios for amniotic fluid samples obtained from diabetic and nondiabetic pregnancies and also between transabdominally or vaginally collected samples uncontaminated by blood or meconium. DSPC measurement is at least as good as the L/S ratio in predicting the absence of respiratory distress syndrome. DSPC concentrations were, however, lower in diabetic than in nondiabetic pregnancies, supporting the hypothesis that DSPC synthesis may be impaired in fetuses of diabetic mothers. Visually uncontaminated samples collected transabdominally or vaginally, when grouped according to length of gestation, have similar DSPC values but different L/S ratios. Thus, even in the absence of blood or meconium, DSPC may be a more useful test than the L/S ratio for vaginally pooled samples.

Download Full-text

The impact of vitamin D on fetal and neonatal lung maturation. A systematic review

AJP Lung Cellular and Molecular Physiology ◽

10.1152/ajplung.00117.2014 ◽

2015 ◽

Vol 308 (7) ◽

pp. L587-L602 ◽

Cited By ~ 54

Author(s):

Sine Lykkedegn ◽

Grith Lykke Sorensen ◽

Signe Sparre Beck-Nielsen ◽

Henrik Thybo Christesen

Keyword(s):

Vitamin D ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Bronchopulmonary Dysplasia ◽

Lung Development ◽

Distress Syndrome ◽

Hypovitaminosis D ◽

Laboratory Studies ◽

Lung Maturation ◽

The Impact

Respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) are major complications to preterm birth. Hypovitaminosis D is prevalent in pregnancy. We systematically reviewed the evidence of the impact of vitamin D on lung development, surfactant synthesis, RDS, and BPD searching PubMed, Embase, and Cochrane databases with the terms vitamin D AND (surfactant OR lung maturation OR lung development OR respiratory distress syndrome OR fetal lung OR prematurity OR bronchopulmonary dysplasia). Three human studies, ten animal studies, two laboratory studies, and one combined animal and laboratory study were included. Human evidence was sparse, allowing no conclusions. BPD was not associated with vitamin D receptor polymorphism in a fully adjusted analysis. Animal and laboratory studies showed substantial positive effects of vitamin D on the alveolar type II cell, fibroblast proliferation, surfactant synthesis, and alveolarization. These data support the hypothesis of hypovitaminosis D as a frequent, modifiable risk factor of RDS and BPD, which should be tested in randomized controlled trials on pregnant women, those with threatening preterm delivery, or in the preterm neonates. Future experimental and human studies should aim to identify optimal time windows, vitamin D doses, and cut-off levels for 25-hydroxyvitamin D in interventions against RDS, BPD, and later adverse respiratory outcomes.

Download Full-text