Volume 51, Issue 1, Pages 7-13 (February 2010)

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ABSTRACT

ABSTRACT + REFS

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Lung Maturation: The Survival Miracle of Very Low Birth Weight Infants

Received 7 August 2009; received in revised form 10 August 2009; accepted 28 August 2009.

The increased survival of very preterm infants is generally attributed to improved care strategies. This review develops the thesis that the features of abnormal pregnancies responsible for very preterm deliveries also provide an explanation of why very preterm infants often survive. A normal fetus born at 24 weeks is very unlikely to survive. However, pregnancies that result in deliveries at 24 weeks are generally highly abnormal, and may have been so for prolonged periods prior to the preterm deliveries. Inflammatory or vascular developmental abnormalities resulting in very preterm birth can alter fetal development in such a way that organ system maturation is induced. This is supported clinically by the relative lack of very preterm infants with respiratory distress syndrome. Interventions such as antenatal corticosteroid treatment and postnatal surfactant treatment for infants with respiratory distress syndrome and gentle ventilation strategies maximize fetal adaptations to the abnormal fetal environment and improve outcomes.

Key Words: lung maturation , prematurity , prenatal corticosteroids , respiratory distress syndrome , surfactant

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Article Outline

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References

1. 1 Tyson JE , Parikh NA , Langer J , Green C , Higgins RD . Intensive care for extreme prematurity—moving beyond gestational age . N Engl J Med . 2008;358:1672–1681 . CrossRef

2. 2 Oishi M , Nishida H , Sasaki T . Japanese experience with micropremies weighing less than 600 grams born between 1984 to 1993 . Pediatrics . 1997;99:E7 .

3. 3 Burri PW . Development and growth of the human lung . In: Fishman AP , Fisher AB editor. Handbook of Physiology: The Respiratory System . Bethesda, MD: American Physiologic Society; 1985;p. 1–46 .

4. 4 Jobe AH . The new BPD: an arrest of lung development . Pediatr Res . 1999;46:641–643 . MEDLINE

5. 5 McElrath TF , Hecht JL , Dammann O , et al. Pregnancy disorders that lead to delivery before the 28th week of gestation: an epidemiologic approach to classification . Am J Epidemiol . 2008;168:980–989 . CrossRef

6. 6 Andrews WW , Goldenberg RL , Hauth JC , Cliver SP , Conner M , Goepfert AR . Endometrial microbial colonization and plasma cell endometritis after spontaneous or indicated preterm versus term delivery . Am J Obstet Gynecol . 2005;193:739–745 . Abstract | Full Text | Full-Text PDF (161 KB) | CrossRef

7. 7 Lahra MM , Jeffery HE . A fetal response to chorioamnionitis is associated with early survival after preterm birth . Am J Obstet Gynecol . 2004;190:147–151 . Abstract | Full Text | Full-Text PDF (130 KB) | CrossRef

8. 8 Fanaroff AA , Stoll BJ , Wright LL , et al. Trends in neonatal morbidity and mortality for very low birthweight infants . Am J Obstet Gynecol . 2007;196:147.e1–147.e8 . Abstract | Full Text | Full-Text PDF (809 KB) | Summary PDF (113 KB) | CrossRef

9. 9 Laughon M , Allred EN , Bose C , et al. Patterns of respiratory disease during the first 2 postnatal weeks in extremely premature infants . Pediatrics . 2009;123:1124–1131 .

10. 10 Verder H , Albertsen P , Ebbesen F , et al. Nasal continuous positive airway pressure and early surfactant therapy for respiratory distress syndrome in newborns of less than 30 weeks' gestation . Pediatrics . 1999;103:E24 .

11. 11 Ammari A , Suri MS , Milisavljevic V , et al. Variables associated with the early failure of nasal CPAP in very low birth weight infants . J Pediatr . 2005;147:341–347 . Abstract | Full Text | Full-Text PDF (140 KB) | CrossRef

12. 12 Morley CJ , Davis PG , Doyle LW , Brion LP , Hascoet JM , Carlin JB . Nasal CPAP or intubation at birth for very preterm infants . N Engl J Med . 2008;358:700–708 . CrossRef

13. 13 Jobe A , Ikegami M . Surfactant for the treatment of respi ratory distress syndrome . Am Rev Respir Dis . 1987;136:1256–1275 . MEDLINE

14. 14 Weaver TE , Conkright JJ . Function of surfactant proteins b and c . Annu Rev Physiol . 2001;63:555–578 . MEDLINE | CrossRef

15. 15 Andrews WW , Goldenberg RL , Faye-Petersen O , Cliver S , Goepfert AR , Hauth JC . The Alabama preterm birth study: polymorphonuclear and mononuclear cell placental infiltrations, other markers of inflammation, and outcomes in 23-to 32-week preterm newborn infants . Am J Obstet Gynecol . 2006;195:803–808 . Abstract | Full Text | Full-Text PDF (155 KB) | CrossRef

16. 16 Soraisham AS , Singhal N , McMillan DD , Sauve RS , Lee SK . A multicenter study on the clinical outcome of chorioamnionitis in preterm infants . Am J Obstet Gynecol . 2009;200:372.e1–372.e6 . Abstract | Full Text | Full-Text PDF (249 KB) | Summary PDF (203 KB) | CrossRef

17. 17 Watterberg KL , Demers LM , Scott SM , Murphy S . Chorioamnionitis and early lung inflammation in infants in whom bronchopulmonary dysplasia develops . Pediatrics . 1996;97:210–215 .

18. 18 Goldenberg RL , Andrews WW , Goepfert AR , et al. The alabama preterm birth study: umbilical cord blood ureaplasma urealyticum and mycoplasma hominis cultures in very preterm newborn infants . Am J Obstet Gynecol . 2008;198:43.e1–43.e5 . Abstract | Full Text | Full-Text PDF (123 KB) | Summary PDF (94 KB) | CrossRef

19. 19 Bry K , Lappalainen U , Hallman M . Intraamniotic interleukin-1 accelerates surfactant protein synthesis in fetal rabbits and improves lung stability after premature birth . J Clin Invest . 1997;99:2992–2999 . MEDLINE | CrossRef

20. 20 Kallapur SG , Nitsos I , Moss TJ , et al. Il-1 mediates pulmonary and systemic inflammatory responses to chorioamnionitis induced by lipopolysaccharide . Am J Respir Crit Care Med . 2009;179:955–961 . CrossRef

21. 21 Jobe AH , Newnham JP , Willet KE , et al. Endotoxin induced lung maturation in preterm lambs is not mediated by cortisol . Am J Respirt Crit Care Med . 2000;162:1656–1661 .

22. 22 Moss TJM , Nitsos I , Knox CL , et al. Ureaplasma colonization of amniotic fluid and efficacy of antenatal corticosteroids for preterm lung maturation in sheep . Am J Obstet Gynecol . 2009;200:96.e1; 96.96 . Abstract | Full Text | Full-Text PDF (485 KB) | Summary PDF (225 KB) | CrossRef

23. 23 Chang EY , Menard MK , Vermillion ST , Hulsey T , Ebeling M . The association between hyaline membrane disease and preeclampsia . Am J Obstet Gynecol . 2004;191:1414–1417 . Abstract | Full Text | Full-Text PDF (120 KB) | CrossRef

24. 24 Roberts D , Dalziel S . Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth . Cochrane Database Syst Rev . 2006;3: CD004454. .

25. 25 Jobe AH . Prenatal corticosteroids: a neonatologist's perspective . Neoreviews . 2006;7:e259–e267 .

26. 26 Jobe AH . Why surfactant works for respiratory distress syndrome . Neoreviews . 2006;7:e95–105 .

27. 27 Newnham J , Kallapur SG , Kramer BW , et al. Betamethasone effects on chorioamnionitis induced by intra-amniotic endotoxin in sheep . Am J Obstet Gynecol . 2003;189:1458–1466 . Abstract | Full Text | Full-Text PDF (1077 KB) | CrossRef

28. 28 Jobe AH , Mitchell BR , Gunkel JH . Beneficial effects of the combined use of prenatal corticosteroids and postnatal surfactant on preterm infants . Am J Obstet Gynecol . 1993;168:508–513 . MEDLINE

Division of Neonatology/Pulmonary Biology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA

Corresponding author. Cincinnati Children's Hospital, Division of Pulmonary Biology, 3333 Burnet Avenue, Cincinnati, OH 45229-3039, USA

PII: S1875-9572(10)60003-4

doi:10.1016/S1875-9572(10)60003-4

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