Prenatal prevention of respiratory distress syndrome: new pharmacologic approaches

doi:10.1016/0378-3782(92)90165-D

Early Human Development

Volume 29, Issues 1–3, June–July 1992, Pages 283-286

https://doi.org/10.1016/0378-3782(92)90165-D Get rights and content

Abstract

A deficit of lung surfactant is known to be involved in the pathophysiology of the respiratory distress syndrome of the neonate (RDS), which is still responsible of about one fourth of total neonatal mortality. It has been well documented that maternal administration of corticosteroids enhances fetal lung maturity, promoting synthesis of surfactants and altering also the structure of the lung parenchyma. Although the beneficial effects of corticosteroids have been substantiated by a number of experimental evidences and clinical studies, about 10% of the treated neonates remains affected by RDS. Corticosteroids affect the composition of lung parenchyma, by increasing elastin content and by decreasing alveolo-capillary permeability to serum proteins. Since thyrotropic releasing hormone (TRH) has been shown to potentiate the effects of corticosteroids a combination of the two drugs may be the treatment of choice for prenatal prevention of RDS.

References (17)

T.A. Doran et al.
Results of a double-blind controlled study on the use of betamethasone in the prevention of respiratory distress syndrome
Am. J. Obstet. Gynecol.
(1980)
M. Oulton et al.
Gestation-dependent effects of the combined treatment of glucocorticoids and thyrotropin-releasing hormone on surfactant production by fetal rabbit lung
Am. J. Obstet. Gynecol.
(1989)
E.E. Farrell et al.
Impact of antenatal dexamethasone administration on respiratory distress syndrome in surfactant-treated infants
Am. J. Obstet. Gynecol.
(1989)
B.L. Tabor et al.
Dose response of thyrotropin-releasing hormone on pulmonary maturation in corticosteroid-treated preterm rabbits
Am. J. Obstet. Gynecol.
(1990)
B.L. Tabor et al.
Doe effect of antenatal corticosteroids for induction of lung maturation in preterm rabbits
Am. J. Obstet. Gynecol.
(1991)
F.L. Ballard
Combined hormonal treatment and lung maturation
Semin. Perinatol.
(1984)
Effect of antenatal dexamethasone administration on the prevention of respiratory distress syndrome
Am. J. Obstet. Gynecol.
(1981)
H.W. Taeusch et al.
Magnitude and duration of lung response to dexamethasone in fetal sheep
Am. J. Obstet. Gynecol.
(1981)

There are more references available in the full text version of this article.

Cited by (15)

Aqueous dispersion stability of multi-carbon nanoparticles in anionic, cationic, neutral, bile salt and pulmonary surfactant solutions
2010, Colloids and Surfaces A: Physicochemical and Engineering Aspects
Molecular structure of surfactants governs the dispersion stability of, poorly soluble and mainly hydrophobic, carbon nanoparticles in solvents. A systematic study was carried out to establish the surfactant assisted dispersion mechanism of carbon nanoclusters (size ≈150 nm, zeta potential ≈−15 mV), obtained from soot, in water. An array of surfactants, SDS, CTAB, TX-100, sodium cholate (bile salt) and dipalmitoyl phosphatidylcholine (DPPC, a clinical pulmonary surfactant preparation called Survanta), were used in a wide range of concentration (0.01CMC to 2CMC) to probe the dispersion mechanism. Results revealed that the adsorption of surfactant molecules on the nanoparticle surface was interplay of ionic, hydrophobic and π–π stacking forces. The CTAB molecules (cationic) formed a bilayer on the carbon nanoclusters providing robust dispersion stability whereas SDS molecules (anionic) were poorly adsorbed through hydrophobic interactions. TX-100 molecules (neutral) stabilized the dispersion via hydrophobic and π–π stacking interactions. Sodium cholate, adsorbed on nanoclusters mostly through hydrophobic interaction and generated large asymmetric complexes. DPPC, a gemini surfactant, formed a rigid monolayer around the carbon nanocluster even at nanomolar concentration and provided excellent stability to the dispersion. Binding constant for adsorption onto a hydrophobic surface or being part of membrane/micelles was found to be energetically most favorable for TX-100 followed by CTAB, NaC and SDS in that order. A comparison with carbon nanotubes data indicates that surfactant assisted dispersion stability is sensitive to the size and morphology of the carbonaceous nanostructure.
Maturation of human fetal responses to airborne sound in low- and high-risk fetuses
2000, Early Human Development
The purpose of the study was to characterize the onset and maturation of airborne sound-elicited responses in low- and high-risk preterm fetuses. In Study 1, a total of 91 low-risk fetuses at 27, 30, 33, and 36 weeks GA received three sound trials at 90, 100, 105 and 110 dB and three no-stimulus control trials. The onset of cardiac acceleration and body movement responses occurred at 30 weeks GA. Maturation of the cardiac response was observed with a decrease in threshold from 105–110 dB at 33 weeks GA to 100–105 dB at 36 weeks GA. In Study 2, the procedure was similar except that the 43 high-risk fetuses at 27, 30 and 33 weeks GA did not receive sounds at 90 dB. For the high-risk fetuses, the onset of cardiac and motor responses also occurred at 30 weeks GA. At 33 weeks GA, those high-risk fetuses subsequently born at term showed an increased magnitude of the cardiac acceleration response compared to low-risk fetuses. The results indicate that both low- and high-risk fetuses begin responding to sounds at the same gestational age. Differential responses observed over gestation in the high-risk group most likely indicate differential functional development of the auditory-response system.
Maturation of body and breathing movements in 24-33 week-old fetuses threatening to deliver prematurely
1999, Early Human Development
Maturation of spontaneous fetal body and breathing movements of 24 to 33-week-old fetuses in 168 pregnancies threatening to deliver prematurely were examined on the basis of newborn outcome (premature compromised, premature healthy, term healthy). Maturation of fetuses in 60 low-risk pregnancies delivering as healthy full-term infants served as a normative comparison group. Each fetus was observed for 30 min; the amount of body and breathing movements were noted and an estimation of amniotic fluid volume was made. The pattern of behavioural maturation was similar for all outcome groups; with advancing gestation there was a decrease in body movements and an increase in breathing movements. Both reduced activity levels and advanced behaviours were observed in the high-risk outcome groups. The high-risk fetuses had reduced levels of body movements which increased with better outcome and, an earlier onset of increased amounts of breathing, occurring at 30 weeks in contrast to 33 weeks for the comparison group. In the presence of ruptured membranes, those high-risk fetuses who were born prematurely had less breathing compared to those who delivered at term. Similar maturation patterns among high- and low-risk outcome groups suggests normal/typical functional development in the high-risk fetal groups. The observed differential behaviours were associated with prematurity and most likely associated with events leading to premature labour.
Cost savings from the use of antenatal steroids to prevent respiratory distress syndrome and related conditions in premature infants
1995, American Journal of Obstetrics and Gynecology
Prevention of Chronic Morbidities in Extremely Premature Newborns with LISA-nCPAP Respiratory Therapy and Adjuvant Perinatal Strategies
2023, Antioxidants
Thyroxine and Thyroid-Stimulating Hormone in Own Mother’s Milk, Donor Milk, and Infant Formula
2022, Life

View all citing articles on Scopus

^☆: This work was supported by CNR and MURST, Italy.

View full text

Prenatal prevention of respiratory distress syndrome: new pharmacologic approaches☆

Abstract

Am. J. Obstet. Gynecol.

Am. J. Obstet. Gynecol.

Am. J. Obstet. Gynecol.

Am. J. Obstet. Gynecol.

Am. J. Obstet. Gynecol.

Combined hormonal treatment and lung maturation

Semin. Perinatol.

Effect of antenatal dexamethasone administration on the prevention of respiratory distress syndrome

Am. J. Obstet. Gynecol.

Magnitude and duration of lung response to dexamethasone in fetal sheep

Am. J. Obstet. Gynecol.