losartan-potassium and Respiratory-Distress-Syndrome--Newborn

Mechanical ventilation is a risk factor for cerebral inflammation and brain injury in preterm neonates. The risk increases proportionally with the intensity of treatment. Recent studies have shown that cerebral inflammation and injury can be initiated in the delivery room. At present, initiation of intermittent positive pressure ventilation (IPPV) in the delivery room is one of the least controlled interventions a preterm infant will likely face. Varying pressures and volumes administered shortly after birth are sufficient to trigger pathways of ventilation-induced lung and brain injury. The pathways involved in ventilation-induced brain injury include a complex inflammatory cascade and haemodynamic instability, both of which have an impact on the brain. However, regardless of the strategy employed to deliver IPPV, any ventilation has the potential to have an impact on the immature brain. This is particularly important given that preterm infants are already at a high risk for brain injury simply due to immaturity. This highlights the importance of improving the initial respiratory support in the delivery room. We review the mechanisms of ventilation-induced brain injury and discuss the need for, and the most likely, current therapeutic agents to protect the preterm brain. These include therapies already employed clinically, such as maternal glucocorticoid therapy and allopurinol, as well as other agents, such as erythropoietin, human amnion epithelial cells and melatonin, already showing promise in preclinical studies. Their mechanisms of action are discussed, highlighting their potential for use immediately after birth.

Topics: Brain Injuries; Delivery Rooms; Erythropoietin; Female; Glucocorticoids; Humans; Infant, Newborn; Infant, Premature; Intermittent Positive-Pressure Ventilation; Melatonin; Pregnancy; Prenatal Care; Randomized Controlled Trials as Topic; Respiratory Distress Syndrome, Newborn

Comparing a group of infants treated with recombinant erythropoietin and iron supplementation to a group of control infants, no difference was observed concerning the transfusion need. The incidence of retinopathy of prematurity was significantly higher in the treated group. These data need to be confirmed in randomized controlled studies.

Topics: Blood Transfusion; Erythropoietin; Ferric Compounds; Ferritins; Hematocrit; Humans; Incidence; Infant, Newborn; Recombinant Proteins; Respiratory Distress Syndrome, Newborn; Retinopathy of Prematurity; Severity of Illness Index

To explore the association between concentrations of endogenous erythropoietin (EPO) in blood the first 2 weeks of life and neonatal disorders in extremely low gestational age newborns (ELGANs).. Prospective cohort study.. Neonatal care units at 14 participating hospitals in the USA.. 867 children born before the 28th week of gestation from the ELGAN study cohort.. EPO blood concentrations were measured on postnatal days 1, 7 and 14. The following neonatal characteristics and disorders were registered: blood gases, early and late respiratory dysfunction, pulmonary deterioration, retinopathy of prematurity (ROP), necrotising enterocolitis (NEC) and bronchopulmonary dysplasia (BPD). We calculated the gestational age-adjusted ORs for having each disorder associated with an EPO blood concentration in the highest or lowest quartile, compared with infants whose EPO concentration was in the middle two quartiles on the corresponding day.. Newborns whose day-1 EPO was in the highest quartile were at increased risk for early and persistent respiratory dysfunction during the first 2 weeks of life, and NEC requiring surgery. The lowest EPO quartile on day 1 was associated with a decreased risk of moderate BPD. The association between low EPO and decreased risk of respiratory complications persisted on day 7. On day 14, being in the highest EPO quartile was associated with increased risk of ROP, and BPD not requiring ventilation assistance.. EPO blood concentrations in extremely preterm newborns during the first 2 weeks of life convey information about increased risks of bowel, lung and retinal diseases.

Topics: Bronchopulmonary Dysplasia; Enterocolitis, Necrotizing; Erythropoietin; Gestational Age; Humans; Infant, Extremely Premature; Infant, Premature, Diseases; Prospective Studies; Respiratory Distress Syndrome, Newborn; Retinopathy of Prematurity; Risk Factors; Time Factors

Infant respiratory distress syndrome (iRDS) in babies born from women with intrahepatic cholestasis of pregnancy (ICP) has been associated with intrauterine exposure to high bile acid levels. Here, we have investigated the role of macrophages in hypercholanemia-induced changes in maternal and fetal lung. Obstructive cholestasis in pregnant rats (OCP) was maintained from day 14 of gestation to term. Gene expression was determined by RT-QPCR, Western blot, and immunofluorescence. The maternal-fetal bile acid pool was radiolabelled using [(3)H]-taurocholate. OCP resulted in increased bile acids in maternal and fetal organs, including lungs. This was accompanied by structural changes in lung tissue, more marked in fetuses (peribronchial edema, collapse of alveolar spaces and deposits of hyaline material in the alveolar lumen), and infiltration of lung tissue by inflammatory cells. The abundance of macrophages and neutrophils in bronchoalveolar lavage fluid (BALF) was also increased in OCP group. Phospholipase A2-IIA (PLA2), the key enzyme in surfactant degradation, was mainly immunodetected in macrophages, which also expressed the bile acid receptor TGR5. The overall expression of PLA2 was markedly enhanced in maternal and fetal lungs of OCP group and in control maternal BALF cells incubated with bile acids. In neonates born from OCP mothers, the enhanced expression of erythropoietin suggested the presence of hypoxia due to iRDS. In conclusion, these results indicate that the accumulation of bile acids due to maternal cholestasis triggers an inflammatory response in the maternal and fetal lungs together with enhanced macrophage-associated PLA2 expression, which may play an important role in iRDS development.. Maternal cholestasis causes respiratory distress syndrome in rat neonates. Cholestasis in pregnant rats causes bile acid accumulation in the fetal lung. This induces lung macrophages infiltration and inflammatory response. Alveolar macrophages co-express phospholipase A2-IIA and TGR5, but not FXR. Bile acid accumulation stimulates phospholipase A2-IIA, but not TGR5, expression.

Topics: Animals; Bile Acids and Salts; Carrier Proteins; Cholestasis, Intrahepatic; Erythropoietin; Female; Fetus; Gene Expression; Humans; Liver; Lung; Macrophages; Peroxidase; Phospholipases A2; Pneumonia; Pregnancy; Pregnancy Complications; Rats, Wistar; Receptors, Cytoplasmic and Nuclear; Receptors, G-Protein-Coupled; Respiratory Distress Syndrome, Newborn

Our patient is a 26-week-old preterm female infant delivered by caesarean section secondary to severe maternal preeclampsia who had been receiving subcutaneous recombinant erythropoietin (r-EPO) for anemia of prematurity. At 8 weeks of age after 8 doses of r-EPO, the infant developed numerous non-blanching erythematous macules and patches located on the back, posterior shoulder, and posterior arms, concerning for late-onset blueberry muffin lesions. Biopsy of the lesions confirmed dermal hematopoiesis. After r-EPO was discontinued all skin lesions gradually resolved over a period of 2 weeks and never recurred.

Topics: Anemia; Dermis; Erythroblasts; Erythropoietin; Female; Fetal Growth Retardation; Hematopoiesis, Extramedullary; Humans; Infant; Infant, Premature; Infant, Premature, Diseases; Intracranial Hemorrhages; Recombinant Proteins; Respiratory Distress Syndrome, Newborn; Skin Diseases

To determine the relationship between cord blood cotinine levels and some markers of perinatal hypoxia such as cord blood erythropoietin levels, parameters of umbilical arterial blood gas analysis and Apgar scores.. 150 women with uncomplicated, healthy singleton pregnancies were assessed by means of a patient questionnaire. Neonates born by the examined pregnant women were divided into 3 groups according to recorded maternal smoking status--active smoking: n = 51, passive smoking: n = 49, non smoking: n = 50. Immediately after birth umbilical venous (for cotinine and erythropoietin levels) and arterial blood (for pH, pO2, pCO2, BE) were collected.. Cotinine levels were significantly higher (p < 0.00001) in active smoking group (Me = 19.3 ng/ml) than in passive smoking (Me = 0.75 ng/ml) and non smoking (Me = 0.72 ng/ml) ones. Cord blood erythropoietin, pH values and 1, 3 and 5-minute Apgar scores did not differ significantly between the study groups. No significant correlation between cotinine and erythropoietin, pH and Apgar scores results in all study material and in the compared groups was found.. No correlation between cord blood cotinine and erythropoietin levels was detected. Cord blood cotinine concentration does not influence the condition of the newborn assessed by Apgar scores and umbilical arterial blood gas analysis.

Topics: Adult; Biomarkers; Cotinine; Environmental Monitoring; Erythropoietin; Female; Fetal Blood; Humans; Infant, Newborn; Maternal-Fetal Exchange; Poland; Pregnancy; Pregnancy Complications; Prenatal Exposure Delayed Effects; Reference Values; Respiratory Distress Syndrome, Newborn; Risk Assessment; Risk Factors; Smoking; Young Adult

Retinopathy of prematurity (ROP) is a multifactorial disease affecting the developing retinal vasculature and remains an important cause of blindness in very preterm infants. Rush disease, or aggressive posterior ROP (AP-ROP), progresses rapidly to stage 5 disease without exhibiting the classical course that includes stages 1-3. We describe an infant with minimal exposure to oxygen who developed AP-ROP that led to bilateral retinal detachments and a poor visual outcome, despite following current recommended screening guidelines.

Topics: Adrenal Cortex Hormones; Adult; Continuous Positive Airway Pressure; Erythropoietin; Female; Humans; Hypertension, Pregnancy-Induced; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature; Light Coagulation; Male; Neonatal Screening; Oxygen; Pregnancy; Respiratory Distress Syndrome, Newborn; Retinopathy of Prematurity

Topics: Asphyxia Neonatorum; Erythropoietin; Female; Gestational Age; Humans; Hypoxia; Infant, Newborn; Infant, Premature; Iron Isotopes; Male; Pregnancy; Respiratory Distress Syndrome, Newborn; Umbilical Cord