Amniotic fluid phosphatidylglycerol and the lecithin/sphingomyelin ratio in the assessment of fetal lung maturity

Whittle, Martin; Wilson, Andy; Whitfield, C. R.; Paton, Robert D.; Logan, R. W.

doi:10.1111/j.1471-0528.1982.tb05099.x

Cited by 29 publications

(5 citation statements)

References 14 publications

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“…Similarly, an L/S ratio <2.0 with PG indicates RDS is unlikely in the sampled twin but there may be a slight risk for the unsampled co-twin. (Although no baby with an L/S ratio (2.0 with PG developed RDS in our small series, Whittle et al (1982) have already shown in singletons that this profile is associated with a 3-4% incidence of RDS). An L/S ratio <2 with absent PG in the sampled sac indicates a high risk of RDS for both twins.…”

Section: Discussioncontrasting

confidence: 44%

Amniotic fluid phospholipid profile in multiple pregnancy and the effect of zygosity

Dobbie

Whittle

Wilson

et al. 1983

BJOG

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Because respiratory distress syndrome (RDS) may occur in one twin but not the other it may be misleading to assess fetal lung maturity using amniotic fluid from only one sac. We compared the amniotic fluid lecithin/sphingomyelin (L/S), phosphatidyl glycerol/sphingomyelin (PG/S) and phosphatidyl inositol/sphingomyelin (PI/S) ratios between cotwins and co-triplets in 32 sets of twins and three set of triplets. In the twin pregnancies we found a weak correlation for L/S ratio but a much improved one for PG/S and PI/S. The concordance between sacs for all three ratios was better in monozygotic than in dizygotic twins. The efficacy of amniotic fluid PG in the determination of fetal lung maturity was demonstrated and the discrepancies between the sacs was much less for

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Section: Discussioncontrasting

confidence: 44%

Amniotic fluid phospholipid profile in multiple pregnancy and the effect of zygosity

Dobbie

Whittle

Wilson

et al. 1983

BJOG

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“…The fraction of PI in human amniotic fluid PL declines during the final 5 wk before delivery, whereas the PG fraction increases (18). PG appears to be an important modifier of surfactant function (1 9), and its deficiency in amniotic fluid is associated with an increased incidence of HMD (20,21). PG is undetectable in the tracheal effluent of human infants with HMD prior to recovery, but its appearance coincides with clinical improvement (1,15,16).…”

Section: Discussionmentioning

confidence: 99%

Surfactant Quantity and Composition during Recovery from Hyaline Membrane Disease

et al. 1986

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ABSTRACT. The appearance of phosphatidylglycerol in TLC, total lung capacity (in vivo) the tracheal wash of infants with hyaline membrane disease V,,,, maximal lung volume (postmortem) (HMD) has been reported to be associated with clinical ANOVA, one-way analysis of variance signs of recovery. We analyzed lung tissue and bronchoalveolar lavage surfactant in an animal model of HMD to determine whether phosphatidylglycerol or some other component is necessary -for ricGkry. The amount and composition of phospholipid (PL) was determined in the premature Macaca nemestrina monkey (140 days' gestation) during an acute stage of HMD, and in two stages of recovery. These changes were compared to observations made in healthy premature controls (140 days), gestational age-matched fetuses (140 days), and fetuses of 150 days' gestation (term = 168 days). The amount of PL and its surfactant composition in lung homogenates of the right lower lobe and in lavage of the excised left lung was determined. Compared to 140-day fetuses, the healthy controls had a several-fold increase in lavage PL and disaturated phosphatidylcholine (DSPC) during the first few days of life (p < 0.05). Prior to recovery, animals with HMD had no such increase in lavage PL or DSPC and demonstrated poor deflation stability. Recovery was associated with increased tissue and lavage PL ( p < 0.05) and increased fractions of phosphatidylinositol and DSPC ( p < 0.05), but not phosphatidylglycerol. The tissue compositional changes observed during recovery reflected maturational changes observed in the fetal animals studied at 10 days' greater gestational age. Increases in lavage DSPC beyond 2 mg/g dry lung were not associated with further increases in deflation stability. We conclude that increases in DSPC and phosphatidylinositol are associated with recovery from HMD but phosphatidylglycerol does not appear necessary for either improved deflation stability or clinical recovery. (Pediatr Res 20: 1243-1247, 1986 Abbreviations HMD, hyaline membrane disease PL, phospholipid PC, phosphatidylcholine DSPC, disaturated phosphatidylcholine UPC, unsaturated phosphatidylcholine PG, phosphatidylglycerol PI, phosphatidylinositol PE, phosphatidylethanolamine PS, phosphatidylserine SPH, sphingomyelin Received March 20, 1986; accepted July 11, 1986 It is not known whether or not recovery from HMD is contingent on the production of a minimal amount of surface active material and, if so, how much is needed. Although it has been proposed that certain surfactant components, such as PG, may be necessary for recovery (I), studies on pulmonary surfactant composition in human infants during recovery have been limited to examination of tracheal wash. Because of the low mortality during recovery from HMD, it has been impossible to determine the changes in tissue production of PL during recovery or to relate these changes to PL present in the alveolar lavage. The appropriate balance of tissue and alveolar quantities, and the optimal composition of surfactant components needed for recover...

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“…It is well recognized that the measurement of PG improves the predictive accuracy of the L/S ratio in most pregnancies (Kulovich et al 1979;Hallman & Teramo 1981;Whittle et al 1982). This is also true of diabetic pregnancies (Hallman & Teramo 1981).…”

Section: Discussionmentioning

confidence: 96%

Maternal diabetes and neonatal respiratory distress. II. Prediction of fetal lung maturity

James

Chiswick

Harkes

et al. 1984

BJOG

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summary Fifty babies were born at ≤ 37 weeks to mothers with diabetes. Delivery was undertaken in all patients with the reassurance that the L/S ratio was ≥2.0 within the preceding 72 h. Five babies (10%) developed respiratory distress syndrome (RDS). Prediction of fetal lung maturity was improved dramatically by measuring amniotic fluid concentrations of phosphatidylcholine (PC), phosphatidylinositol (PI) and phosphatidyl‐glycerol (PG). Fourteen babies were predicted as having ‘no surfactant’ (PC < 20 mg/1, PI < 2 mg/1 and PG < 2 mg/1), five developed RDS. None of the remaining 36 babies developed the illness: they were predicted as having either ‘early surfactant’ (PC ≥ 20 mg/1, PI ≥ 2 mg/1 but PG < 2 mg/1) or ‘late surfactant’ (PC ≥ 20 mg/1, PI ≥ 2 mg/1 and PG ≥ 2 mg/1). Measurement of PC levels alone was the most accurate method of predicting RDS. There was a significant association between low surfactant phospholipid concentrations and the development of transient tachypnoea of the newborn.

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Amniotic fluid phosphatidylglycerol and the lecithin/sphingomyelin ratio in the assessment of fetal lung maturity

Cited by 29 publications

References 14 publications

Amniotic fluid phospholipid profile in multiple pregnancy and the effect of zygosity

Amniotic fluid phospholipid profile in multiple pregnancy and the effect of zygosity

Surfactant Quantity and Composition during Recovery from Hyaline Membrane Disease

Maternal diabetes and neonatal respiratory distress. II. Prediction of fetal lung maturity

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