In Quest of the Prevention of Hyaline Membrane Disease

1977 ◽  
Vol 86 (5) ◽  
pp. 573-576 ◽  
Author(s):  
Mary Ellen Avery
Keyword(s):  
Fetal Lung ◽  
Hyaline Membrane Disease ◽  
Maternal Diabetes ◽  
Lung Maturation ◽  
Familial Predisposition ◽  
Surfactant Synthesis ◽  
Elective Delivery ◽  
Hyaline Membrane ◽  
Specific Receptors ◽  
Prematurely Born Infants

Hyaline membrane disease or respiratory distress syndrome of prematurely born infants is more common in males, in Caucasians, has a familial predisposition, and is associated with maternal diabetes and delivery by cesarean section before the onset of labor. Now known to be the sequel of surfactant deficiency, it can be predicted prenatally by assay of amniotic liquid for surface active materials produced by the fetal lung. Deficiency of adequate surfactant synthesis or secretion can result in low levels of lecithins and other phospholipids in amniotic liquid. Lung maturation can be accelerated if labor or elective delivery can be deferred at least 24 hours. Glucocorticoids given to the mother cross the placenta and enter fetal lung tissues; specific receptors exist in the lung which permit glucocorticoids to promote cell differentiation and surfactant synthesis precociously. Clinical trials support the efficacy and lack of short-term toxicity of glucocorticoids in human pregnancy after 28 weeks gestation in the event of premature onset of labor. Maternal toxemia, infection or illness which may be aggravated by glucocorticoids may contraindicate prenatal treatment. Postnatally endogenous glucocorticoids accelerate lung maturation, and further administration confers no additional benefit.

Hyaline membrane disease in black newborns: does fetal lung maturation occur earlier?

1994 ◽  
Vol 55 (3) ◽  
pp. 157-161 ◽  
Author(s):  
Pierre-Yves Robillard ◽  
Thomas C. Hulsey ◽  
Greg R. Alexander ◽  
Marie-Pierre Sergent ◽  
François de Caunes ◽  
...  
Keyword(s):  
Fetal Lung ◽  
Hyaline Membrane Disease ◽  
Lung Maturation ◽  
Hyaline Membrane ◽  
Fetal Lung Maturation

Fetal lung maturity in complicated pregnancy, as predicted from microviscosity of amniotic fluid.

1982 ◽  
Vol 28 (8) ◽  
pp. 1754-1757 ◽  
Author(s):  
N V Simon ◽  
W A Hohman ◽  
R C Elser ◽  
J S Levisky ◽  
M J Carp ◽  
...  
Keyword(s):  
Amniotic Fluid ◽  
Fetal Lung ◽  
Hyaline Membrane Disease ◽  
Lung Maturation ◽  
Class D ◽  
Hyaline Membrane ◽  
Induced Hypertension ◽  
Complicated Pregnancy ◽  
Fetal Lung Maturation ◽  
Lung Maturity

Abstract We measured the microviscosity of amniotic fluid between 28 and 40 weeks of gestation in 252 normal pregnancies and in 172 pregnancies complicated by factors known to influence fetal lung maturation, including chronic high blood pressure, pregnancy-induced hypertension, diabetes mellitus, and therapy with betamethasone. Comparison of the microviscosity value distributions and regression analysis indicated significantly lower microviscosity values in hypertensive disorders, in Class D and Classes F or R diabetes, and after 48 h of treatment with betamethasone. Few changes were observed in Classes A, B, or C diabetes. These observations are consistent with the accelerated maturation of surfactant observed in chronic intrauterine stress and the lower incidence of hyaline membrane disease reported after glucocorticoids.

Racial and Environmental Influences on Fetal Lung Maturation

PEDIATRICS ◽  
1981 ◽  
Vol 68 (6) ◽  
pp. 790-795
Author(s):  
Samuel Ross ◽  
Richard L. Naeye
Keyword(s):  
South African ◽  
Fetal Lung ◽  
Hyaline Membrane Disease ◽  
The United States ◽  
African Women ◽  
The South ◽  
Lung Maturation ◽  
The Us ◽  
Hyaline Membrane ◽  
Fetal Lung Maturation

Claims that fetal lung maturation is more rapid in blacks than in whites were investigated. Histologic measurements of lung maturation and the frequency of hyaline membrane disease were compared in four groups of neonates: 490 South African blacks, 841 Ethiopians, 767 US blacks, and 560 US whites. Lungs matured much more rapidly in the Ethiopian and more slowly in the South African than in the US fetuses. The rate of maturation was about the same in US blacks and whites. Hyaline membrane disease was more frequent in the South Africans and less frequent in the Ethiopians than in either US group. Environmental factors in the mother may explain some of these differences. Lungs matured more rapidly in the fetuses of cigarette smokers than in fetuses of nonsmokers. Half of the US mothers but almost none of the South African mothers smoked during pregnancy. The rate of lung maturation had an inverse correlation with maternal body weights. The South African women were heavier and the Ethiopians lighter than women in the United States.

ADRENAL GLAND STRUCTURE AND THE DEVELOPMENT OF HYALINE MEMBRANE DISEASE

PEDIATRICS ◽  
1971 ◽  
Vol 47 (4) ◽  
pp. 650-657
Author(s):  
Richard L. Naeye ◽  
Howard T. Harcke ◽  
William A. Blanc
Keyword(s):  
Adrenal Glands ◽  
Hyaline Membrane Disease ◽  
Alveolar Cells ◽  
Cortical Function ◽  
Lung Maturation ◽  
Cortical Cells ◽  
Corticosteroid Administration ◽  
Osmiophilic Granules ◽  
Hyaline Membrane ◽  
Type Ii Alveolar Cells

Adrenal cortical function may influence the development of hyaline membrane disease. Corticosteroid administration to animal fetuses reportedly accelerates some parameters of lung maturation. Analysis of 387 consecutive autopsies on human neonates demonstrated that adrenal glands were 19% lighter in infants with hyaline membrane disease than in those without the disorder owing to a greater number of adrenal cortical cells in the latter infants. A positive correlation was found between the presence of infection arising before birth and the absence of hyaline membrane disease, the infected infants having larger adrenal glands. It was found that anencephalic neonates who had little or no adrenal fetal cortical zone and half sized adult zones had 45% the mass of osmiophilic granules in pulmonary type II alveolar cells as did nonanencephalic control infants. The osmiophilic granules are reportedly the anatomic representation of surfactant.

Lamellar body phospholipid content of amniotic fluid and L/S ratio compared in assessing fetal lung maturity.

1980 ◽  
Vol 26 (6) ◽  
pp. 766-769 ◽  
Author(s):  
C G Duck-Chong ◽  
J M Gupta ◽  
G N Storey ◽  
C R Houghton
Keyword(s):  
Amniotic Fluid ◽  
Lamellar Body ◽  
Fetal Lung ◽  
Hyaline Membrane Disease ◽  
Phospholipid Content ◽  
Human Amniotic Fluid ◽  
Respiratory Problems ◽  
Fetal Lung Maturity ◽  
Hyaline Membrane ◽  
Lung Maturity

Abstract A micro-method has been devised for isolating a lung-derived membranous fraction from human amniotic fluid. The phospholipid content of this fraction, known as lamellar body phospholipid, provides an indication of fetal lung maturity (Ann. Clin. Biochem 16: 191, 1979). This method has now been applied to 479 samples of amniotic fluid from 330 pregnancies. The lecithin/sphingomyelin ratio has also been determined for each of the samples by the routine method currently in use in the hospitals providing the samples. Hyaline membrane disease was associated with a low concentration of lamellar body phospholipid (< 35 mg/L) in all eight cases encountered in this study. In contrast, in 182 of the 185 cases where the lamellar body content of the amniotic fluid, collected within two days of delivery, exceeded 35 mg/L, the infants were free from serious respiratory problems. Data are presented which suggests that the lecithin/sphingomyelin ratio falsely indicated lung immaturity in many cases, amounting to 44% or more of all values indicating immaturity that were reported.

Lamellar body phospholipid content of amniotic fluid and L/S ratio compared in assessing fetal lung maturity.

1980 ◽  
Vol 26 (6) ◽  
pp. 766-769
Author(s):  
C G Duck-Chong ◽  
J M Gupta ◽  
G N Storey ◽  
C R Houghton
Keyword(s):  
Amniotic Fluid ◽  
Lamellar Body ◽  
Fetal Lung ◽  
Hyaline Membrane Disease ◽  
Phospholipid Content ◽  
Human Amniotic Fluid ◽  
Respiratory Problems ◽  
Fetal Lung Maturity ◽  
Hyaline Membrane ◽  
Lung Maturity

Abstract A micro-method has been devised for isolating a lung-derived membranous fraction from human amniotic fluid. The phospholipid content of this fraction, known as lamellar body phospholipid, provides an indication of fetal lung maturity (Ann. Clin. Biochem 16: 191, 1979). This method has now been applied to 479 samples of amniotic fluid from 330 pregnancies. The lecithin/sphingomyelin ratio has also been determined for each of the samples by the routine method currently in use in the hospitals providing the samples. Hyaline membrane disease was associated with a low concentration of lamellar body phospholipid (< 35 mg/L) in all eight cases encountered in this study. In contrast, in 182 of the 185 cases where the lamellar body content of the amniotic fluid, collected within two days of delivery, exceeded 35 mg/L, the infants were free from serious respiratory problems. Data are presented which suggests that the lecithin/sphingomyelin ratio falsely indicated lung immaturity in many cases, amounting to 44% or more of all values indicating immaturity that were reported.

Improved procedure for lecithin/sphingomyelin ratio in amniotic fluid reduces false predictions of lung immaturity.

1982 ◽  
Vol 28 (2) ◽  
pp. 344-348 ◽  
Author(s):  
L M Brown ◽  
C G Duck-Chong ◽  
W J Hensley
Keyword(s):  
Amniotic Fluid ◽  
Clinical Performance ◽  
Fetal Lung ◽  
Hyaline Membrane Disease ◽  
Hyaline Membrane

Abstract Many laboratories have found that their procedure for determining lecithin/sphingomyelin (L/S)ratios gives an unacceptably high proportion of false predictions of fetal lung immaturity. We investigated each step in the procedure, in an attempt to improve the clinical performance of the test and to make the method more amenable to standardization between laboratories. L/S ratios were determined by the new procedure in amniotic fluid from 147 pregnancies, collected within two days of delivery of the infant. Four cases had an L/S ratio less than 2; all developed hyaline membrane disease. No other cases of hyaline membrane disease were encountered in this study. For 106 of these pregnancies, the L/S ratio was also determined by the procedure previously in use. This predicted lung immaturity for 16 infants, only four of whom developed hyaline membrane disease. All 12 cases incorrectly predicted as immature by the old procedure were correctly classified by the new procedure.

Effect of Maternal Diabetes on Fetal Lung Maturation

1990 ◽  
pp. 251-254
Author(s):  
Angeles Zapata ◽  
José M. Hernández-García ◽  
Cristina Grande ◽  
Isabel Martínez ◽  
Jesús Pérez
Keyword(s):  
Fetal Lung ◽  
Maternal Diabetes ◽  
Lung Maturation ◽  
Fetal Lung Maturation

Measurement of "lamellar body phospholipid" in amniotic fluid as a method for assessing fetal lung maturity.

1981 ◽  
Vol 27 (11) ◽  
pp. 1851-1855 ◽  
Author(s):  
C G Duck-Chong ◽  
D J Henderson-Smart ◽  
J M Gupta ◽  
W J Hensley
Keyword(s):  
Amniotic Fluid ◽  
Clinical Laboratory ◽  
Lamellar Body ◽  
Fetal Lung ◽  
Hyaline Membrane Disease ◽  
Phospholipid Content ◽  
Respiratory Problems ◽  
Hyaline Membrane ◽  
Routine Clinical Laboratory ◽  
Lung Maturity

Abstract A simple, rapid micro-method, suitable for use in a routine clinical laboratory, is described for isolating a surfactant fraction from 0.1 mL of human amniotic fluid and measuring its phospholipid content. We determined the phospholipid content of this fraction, referred to as "lamellar body phospholipid," in 451 samples of amniotic fluid collected within two days of delivery and related the data to the respiratory performance of the newborn in every case; 112 of the infants were delivered at 28-37 weeks gestation. The incidence of hyaline membrane disease was inversely related to the concentration of lamellar body phospholipid in the amniotic fluid. Eleven of 12 infants with lamellar body phospholipid values less than 25 mg/L and four of 44 infants with lamellar phospholipid values between 25 and 50 mg/L developed hyaline membrane disease or other serious respiratory problems possibly related to lung immaturity, whereas all of 395 infants with lamellar body phospholipid values of 50 mg/L or more were free from respiratory problems of this nature. The incidence of transient tachypnea was greatest when the lamellar body phospholipid value was between 25 and 50 mg/L, suggesting that this condition may be related to a degree of lung maturity.

The Body Lymphatics in Neonatal Hyaline Membrane Disease

PEDIATRICS ◽  
1969 ◽  
Vol 44 (1) ◽  
pp. 126-128
Author(s):  
J. M. Lauweryns ◽  
M. Deleersnyder ◽  
L. Boussauw
Keyword(s):  
Surface Tension ◽  
Fetal Lung ◽  
Hyaline Membrane Disease ◽  
The Body ◽  
Hyaline Membrane ◽  
Wall Permeability ◽  
Lung Liquid ◽  
Delayed Removal ◽  
Generalized Distribution

In analyzing the significance of the recently reported increase in diameter of the pulmonary lymphatics in neonatal hyaline membrane disease (HMD), it seems pertinent to examine by identical morphometrical methods and in the same infants the occurrence versus the absence of this same phenomenon in some other body organs. Were this lymphangiectasis—as claimed by Stowens—of a very generalized distribution throughout the body, one would indeed have to consider the significance of its occurrence in the lungs in a more general way, i.e., as not only restricted to a more exclusive pulmonary origin (such as a disturbed alveolocapillary wall permeability, a delayed removal of fetal lung liquid, or higher surface tension characteristics).

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