The pulmonary paradox in premature infants: in-utero infected lungs do better than those with accelerated maturation
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J. Ersch
Abstract
Aims: To document, and explain, the pulmonary paradox whereby despite relative lung immaturity, preterm infants exposed to amniotic infection (AI) have better postnatal pulmonary function than those exposed to preeclampsia (PE). Methods: Lung maturation was characterized in 65 preterm perinatal deaths [AI (n=40) and PE (n=25)] and postnatal respiratory function in 100 preterm survivors [AI (n=50) and PE (n=50)]. Results: At autopsy, lung architecture was in advance of gestational age in 5% of AI infants versus 40% of PE infants (P<0.001). In survivors, the groups were similar in age and Apgar scores. At birth, 40% of the AI group required continuous positive airway pressure or mechanical ventilation versus 24% of the PE group (NS). However, 24 hours later, only 1 AI infant had deteriorated compared to 40% of PE infants (P<0.05). Conclusions: Accelerated morphologic lung maturation in preterm PE infants does not translate into improved postnatal respiratory function. Most likely, this is due to a relative lack of surfactant, ascribable to low stimulant cytokine and high TNF-α levels. An intrauterine history supplemented by an antenatal cytokine profile could identify an increased exogeneous surfactant need in preterm infants exposed to PE.
Copyright © 2004 by Walter de Gruyter GmbH & Co. KG
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Artikel in diesem Heft
- Editorial
- The role of ultrasonography in recognizing the cause of fetal cerebral ventriculomegaly
- A kick from within – fetal movement counting and the cancelled progress in antenatal care
- DNA microarrays detect the expression of apoptosis-related genes in preeclamptic placentas
- Indicated labor induction with vaginal prostaglandin E2 increases the risk of cesarean section even in multiparous women with no previous cesarean section
- Cervical immunoglobulin A and altered vaginal flora in pregnant women with threatened preter delivery
- Multiple courses of antenatal corticosteroid therapy in patients with preterm premature rupture of membranes
- Implication of cord blood myeloperoxidase but of soluble p-selectin levels in preterm deliveries
- Fetal and early postnatal magnetic resonance imaging – is there a difference?
- Bone turnover markers and bone strength during the first weeks of life in very low birth weight premature infants
- The ponderal index in triplets: I. Relationship to small for gestational age neonates
- The ponderal index in triplets: II. Gestational age-related patterns of neonatal weights and lengths
- The ponderal index in triplets: III. Association with birth weight discordance
- The ponderal index in triplets: IV. Relationship with maternal height
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- The pulmonary paradox in premature infants: in-utero infected lungs do better than those with accelerated maturation
- Congenital syphilis: unique clinical presentation in three preterm newborns
- Twin-to-twin transfusion syndrome complicated by spontaneous mid-trimester uterine rupture
- Persistent pulmonary hypertension in a premature newborn after 16 hours of antenatal indomethacin exposure
- Congress Calendar
- Roster of Perinatal Societies
