scholarly journals Intra-amniotic LPS and antenatal betamethasone: inflammation and maturation in preterm lamb lungs

2012 ◽  
Vol 302 (4) ◽  
pp. L380-L389 ◽  
Author(s):  
Elke Kuypers ◽  
Jennifer J. P. Collins ◽  
Boris W. Kramer ◽  
Gaston Ofman ◽  
Ilias Nitsos ◽  
...  
Keyword(s):  
Bronchoalveolar Lavage ◽  
Preterm Delivery ◽  
Gestational Age ◽  
Lung Inflammation ◽  
Fetal Lung ◽  
Inflammatory Cells ◽  
Toll Like Receptor ◽  
Lung Maturation ◽  
Toll Like Receptor 2 ◽  
Combined Exposures

The proinflammatory stimulus of chorioamnionitis is commonly associated with preterm delivery. Women at risk of preterm delivery receive antenatal glucocorticoids to functionally mature the fetal lung. However, the effects of the combined exposures of chorioamnionitis and antenatal glucocorticoids on the fetus are poorly understood. Time-mated ewes with singleton fetuses received an intra-amniotic injection of lipopolysaccharide (LPS) either preceding or following maternal intramuscular betamethasone 7 or 14 days before delivery, and the fetuses were delivered at 120 days gestational age (GA) (term = 150 days GA). Gestation matched controls received intra-amniotic and maternal intramuscular saline. Compared with saline controls, intra-amniotic LPS increased inflammatory cells in the bronchoalveolar lavage and myeloperoxidase, Toll-like receptor 2 and 4 mRNA, PU.1, CD3, and Foxp3-positive cells in the fetal lung. LPS-induced lung maturation measured as increased airway surfactant and improved lung gas volumes. Intra-amniotic LPS-induced inflammation persisted until 14 days after exposure. Betamethasone treatment alone induced modest lung maturation but, when administered before intra-amniotic LPS, suppressed lung inflammation. Interestingly, betamethasone treatment after LPS did not counteract inflammation but enhanced lung maturation. We conclude that the order of exposures of intra-amniotic LPS or maternal betamethasone had large effects on fetal lung inflammation and maturation.

Intra-amniotic endotoxin increases pulmonary surfactant proteins and induces SP-B processing in fetal sheep

2001 ◽  
Vol 280 (2) ◽  
pp. L279-L285 ◽  
Author(s):  
Cindy J. Bachurski ◽  
Gary F. Ross ◽  
Machiko Ikegami ◽  
Boris W. Kramer ◽  
Alan H. Jobe
Keyword(s):  
Bronchoalveolar Lavage ◽  
Gestational Age ◽  
Bronchoalveolar Lavage Fluid ◽  
Fetal Lung ◽  
Lavage Fluid ◽  
Surfactant Protein ◽  
Lung Compliance ◽  
Lung Maturation ◽  
Fetal Sheep ◽  
Pulmonary Surfactant Proteins

Intra-amniotic (IA) endotoxin induces lung maturation within 6 days in fetal sheep of 125 days gestational age. To determine the early fetal lung response to IA endotoxin, the timing and characteristics of changes in surfactant components were evaluated. Fetal sheep were exposed to 20 mg of Escherichia coli 055:B5 endotoxin by IA injection from 1 to 15 days before preterm delivery at 125 days gestational age. Surfactant protein (SP) A, SP-B, and SP-C mRNAs were maximally induced at 2 days. SP-D mRNA was increased fourfold at 1 day and remained at peak levels for up to 7 days. Bronchoalveolar lavage fluid from control animals contained very little SP-B protein, 75% of which was a partially processed intermediate. The alveolar pool of SP-B was significantly increased between 4 and 7 days in conjunction with conversion to the fully processed active airway peptide. All SPs were significantly elevated in the bronchoalveolar lavage fluid by 7 days. IA endotoxin caused rapid and sustained increases in SP mRNAs that preceded the increase in alveolar saturated phosphatidylcholine processing of SP-B and improved lung compliance in prematurely delivered lambs.

scholarly journals Successfully delayed delivery of second twin after early second trimester rupture of membranes of the first twin: a case report

2020 ◽  
Vol 12 (2) ◽  
pp. 81-85
Author(s):  
Jadranka Georgievska ◽  
Igor Samardziski ◽  
Ana Daneva ◽  
Goran Kocoski
Keyword(s):  
Preterm Delivery ◽  
Good Condition ◽  
Fetal Lung ◽  
Intrauterine Death ◽  
Lung Maturation ◽  
Uterine Contractions ◽  
Regular Control ◽  
Level Institution ◽  
Twin Pregnancies ◽  
Second Twin

Twin pregnancies are high-risk pregnancies accompanied with multiple complications, such as: spontaneous abortion, preterm rupture of the membranes, preterm delivery, intrauterine death of one or both twins etc. There is no consensus about the management of twin  pregnancies complicated with preterm rupture of the membranes of one twin and risk of preterm delivery. These cases are rarely found in the literature. We present a case of a 35 years old patient, hospitalized in a tertiary level institution, because of a diamniotic dichorionic twin pregnancy complicated with preterm rupture of the membranes of the first twin at 19 weeks of gestation. She had one delivery with Caesarean section 16 years ago. In consultation with the patient induction of labor was done with delivery of the first twin, a death male fetus. After that, antibiotics and tocolytic therapy were administrated and the patient remained in the hospital about one week. The patient was discharged at home with regular control of her condition and condition of the fetus. The patient was again hospitalized at 33 weeks of gestation with uterine contractions on cardiotocography. After administration of corticosteroid therapy for fetal lung maturation she delivered spontaneously the second twin in a good condition and  she was discharged from hospital after 16 days. In twin pregnancies clinicians must think about delayed interval delivery of the second twin, after delivery of the first twin, with an aim to increase chances for survival, especially for pregnancies less than 30 weeks of gestation.

MicroRNA-21 inhibits toll-like receptor 2 agonist–induced lung inflammation in mice

2011 ◽  
Vol 37 (8) ◽  
pp. 500-508 ◽  
Author(s):  
Stephanie R. Case ◽  
Richard J. Martin ◽  
Di Jiang ◽  
Maisha N. Minor ◽  
Hong Wei Chu
Keyword(s):  
Lung Inflammation ◽  
Toll Like Receptor ◽  
Toll Like Receptor 2

Initial responses to ventilation of premature lambs exposed to intra-amniotic endotoxin 4 days before delivery

2004 ◽  
Vol 286 (3) ◽  
pp. L573-L579 ◽  
Author(s):  
Machiko Ikegami ◽  
Suhas G. Kallapur ◽  
Alan H. Jobe
Keyword(s):  
Lung Injury ◽  
Bronchoalveolar Lavage ◽  
Lung Inflammation ◽  
Bronchoalveolar Lavage Fluid ◽  
Fetal Lung ◽  
Lavage Fluid ◽  
Lung Compliance ◽  
Premature Delivery ◽  
Surfactant Treatment ◽  
Endotoxin Exposure

Preterm delivery is frequently preceded by chorioamnionitis, resulting in exposure of the fetal lung to inflammation. We hypothesized that ventilation of the antenatally inflamed lung would result in amplification of the lung injury. Therefore, we induced fetal lung inflammation with intra-amniotic endotoxin (10 mg of Escherichia coli 055:B5) 4 days before premature delivery at 130 days of gestation. Lung function and lung inflammation after surfactant treatment and 4 h of mechanical ventilation were evaluated. Inflammatory cell numbers in amniotic fluid were increased >10-fold by antenatal endotoxin exposure. Antenatal endotoxin exposure had minimal effects on blood pressure, heart rate, lung compliance, and blood gas values. The endotoxin-exposed lungs required higher ventilation pressures. Ventilation did not increase the number of inflammatory cells or the protein in bronchoalveolar lavage fluid of the endotoxin-exposed animals above that measured in endotoxin-exposed fetuses that were not ventilated. IL-1β, IL-6, and IL-8 mRNA in cells from bronchoalveolar lavage fluid were increased by antenatal endotoxin exposure but not changed by ventilation. IL-1β and IL-8 protein was increased in lung tissue by 4 h of ventilation. Very little inflammation was induced by ventilation in this premature lamb model of surfactant treatment and gentle ventilation. After lung inflammation was induced by intra-amniotic endotoxin injection, ventilation did not increase lung injury.

scholarly journals Cardiovascular Hemodynamic Changes After Antenatal Corticosteroids in Growth Restricted and Appropriate for Gestational Age Fetuses

2018 ◽  
Vol 41 (03) ◽  
pp. 292-299 ◽  
Author(s):  
Laura Marchi ◽  
Lucia Pasquini ◽  
Ayten Elvan-Taspinar ◽  
Caterina Maddalena Bilardo
Keyword(s):  
Cardiac Function ◽  
Gestational Age ◽  
Systolic Function ◽  
Fetal Lung ◽  
Ductus Venosus ◽  
Antenatal Corticosteroids ◽  
Lung Maturation ◽  
Before And After ◽  
Single Operator ◽  
Appropriate For Gestational Age

Abstract Purpose To investigate hemodynamic effects after antenatal corticosteroids (ACS) administration in appropriate for gestational age (AGA) and early growth restricted (GR) fetuses by measurement of Doppler cardiovascular function parameters. Materials and Methods Prospective cohort study. AGA and GR singleton pregnancies receiving ACS for fetal lung maturation between 24 + 0–33 + 6 weeks were enrolled. Feto-placental vascular hemodynamics were studied by: umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, renal artery (RenA) PI. Cardiac function was evaluated by ductus venosus (DV) PI and by echocardiographic parameters: E to A wave ratios (E/A) and mitral and tricuspid annular plane systolic excursion (MAPSE and TAPSE) for diastolic function, left and right myocardial performance index (MPI) for overall (diastolic and systolic) function. A single operator performed all the measurements at 3 different time points (E): E0 before or within 4 hours of ACS administration (baseline examination), E1 24–48 hours after the first dose and E2 7 days after the second dose of ACS. The values were expressed as z-scores. Pairwise comparisons with paired t-test were performed to compare measurements before and after exposure to ACS. Results 25 AGA and 20 GR fetuses (mean gestational age: 31 + 1 and 30 + 6, respectively) were included in the analysis. In the AGA group ACS administration was associated with a significant reduction in UA PI. In the GR fetuses ACS temporarily (E0-E1) restored UA-end diastolic flow (EDF) in 6 of 9 fetuses with A/R-EDF (“Return of EDF phenomenon”) and produced a significant increase (worsening) in right MPI (both in E1-E2 and in E0-E2). Conclusion ACS administration is associated with UA vasodilation in both AGA and GR fetuses and with an increase in right MPI in the latter group. This suggests a worsening in cardiac function in GR fetuses.

scholarly journals Non–Mannose-capped Lipoarabinomannan Induces Lung Inflammation via Toll-like Receptor 2

2004 ◽  
Vol 170 (12) ◽  
pp. 1367-1374 ◽  
Author(s):  
Catharina W. Wieland ◽  
Sylvia Knapp ◽  
Sandrine Florquin ◽  
Alex F. de Vos ◽  
Kiyoshi Takeda ◽  
...  
Keyword(s):  
Lung Inflammation ◽  
Toll Like Receptor ◽  
Toll Like Receptor 2

scholarly journals Do maternal demographics and prenatal history impact the efficacy of betamethasone therapy for threatened preterm labor?

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mary T. Kinney ◽  
Sara K. Quinney ◽  
Hayley K. Trussell ◽  
Larissa L. Silva ◽  
Sherrine A. Ibrahim ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Gestational Age ◽  
Race And Ethnicity ◽  
Fetal Lung ◽  
Control Analysis ◽  
Lung Maturation ◽  
Maternal Characteristics ◽  
Individualization Of Therapy ◽  
Gestational Age At Birth ◽  
Age At Birth

Abstract Background Betamethasone (BMZ) is used to accelerate fetal lung maturation in women with threatened preterm birth, but its efficacy is variable and limited by the lack of patient individualization in its dosing and administration. To determine sources of variability and potential opportunities for individualization of therapy, the objective of this study was to evaluate maternal factors associated with development of neonatal respiratory distress syndrome (RDS) in a cohort of women who received betamethasone. Methods This study prospectively enrolled women, gestational ages 23–34 weeks, who received betamethasone for threatened preterm birth. Maternal demographics, prenatal history, and neonatal outcomes were abstracted from hospital records. RDS was the primary outcome. Associations between RDS diagnosis and maternal demographics, prenatal history, and betamethasone dosing were evaluated in a case-control analysis and multivariable regression adjusted for gestational age at delivery. Secondary analyses limited the cohort to women who delivered within 1 or 2 weeks of betamethasone dosing. Results Of 209 deliveries, 90 (43 %) resulted in neonatal RDS. Within the overall cohort and controlling for gestational age at birth, RDS was only associated with cesarean births compared to vaginal births (adjusted OR 1.17 [1.06–1.29]). Route of delivery was also the only significant factor related to RDS in the 83 neonates delivered within 7 days of BMZ dosing. However, among 101 deliveries within 14 days of betamethasone dosing and controlling for gestational age at birth, women who experienced preterm premature rupture of membranes (PPROM) had lower RDS rates than those without PPROM (57.9 % vs. 80.2 %, adjusted OR 0.81 [0.67–0.99]). Maternal age, BMI, race, and ethnicity were not associated with RDS in the regression models. Conclusions Of maternal characteristics analyzed, only delivery by cesarean was associated with neonatal RDS after antenatal betamethasone use.

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

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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