Single Dose Fetal Betamethasone Administration Stabilizes Postnatal Glomerular Filtration Rate and Alters Endocrine Function in Premature Lambs

Mg, Ervin; Lm, Berry; Ikegami, Machiko; Ah, Jobe; Jf, Padbury; Dh, Polk

doi:10.1203/00006450-199611000-00001

Cited by 38 publications

(25 citation statements)

References 27 publications

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“…In clinical practice, the glucocorticoids betamethasone or dexamethasone are administered to pregnant women at risk of preterm delivery in order to accelerate fetal lung maturation [39]. Importantly, exposure to glucocorticoids antenatally is also associated with increased mean arterial blood pressure, renal blood flow and glomerular filtration rate [40,41,42,43,44,45,46], suggesting that accelerated renal functional maturation also occurs.…”

Section: Antenatal Glucocorticoid Administrationmentioning

confidence: 99%

Stereological Assessment of Renal Development in a Baboon Model of Preterm Birth

2011

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At the time when most preterm babies are delivered, nephrogenesis is still ongoing, with the majority of nephrons normally formed during the third trimester of pregnancy. The extrauterine environment, however, is suboptimal for organogenesis, and therefore renal development is likely to be adversely affected by preterm birth. In the long-term, there is emerging evidence of high blood pressure and renal dysfunction amongst young adults born preterm. There is little knowledge to date, however, regarding the effects of preterm birth on renal structural development, perhaps due to the lack of an appropriate animal model. We have demonstrated that the baboon (Papio sp.) has a similar time course of nephrogenesis as the human kidney, and the baboon neonate can also be cared for in the same manner as a human neonate following preterm birth. Through a series of studies assessing renal development in the baboon model of preterm birth, involving the use of gold-standard stereological techniques, we have demonstrated that nephron endowment in the preterm baboon kidney is not reduced. Furthermore, antenatal glucocorticoid exposure prior to preterm delivery was associated with an increase in mature nephrons. There was, however, evidence of morphological abnormalities in a variable percentage of the glomeruli formed ex utero. Further research is therefore essential in order to establish what factors are involved in contributing to the glomerular abnormalities, and to identify ways in which ‘normal’ renal development can be conserved and optimised in the extrauterine setting.

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Section: Antenatal Glucocorticoid Administrationmentioning

confidence: 99%

Stereological Assessment of Renal Development in a Baboon Model of Preterm Birth

2011

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“…45,70,98,126 Of these factors, based on our animal data and human data from previous studies dealing with preterm gestations, it appears that the most effective strategy for accelerating reabsorption of fetal lung fluid would be the administration of exogenous glucocorticoids. 43,48,83,111 High doses of glucocorticoids have been shown to stimulate transcription of ENaC in several sodium transporting epithelia as well as in the lung. 126 In the alveolar epithelia, glucocorticoids were found to induce lung sodium reabsorption in the late gestation fetal lung.…”

Section: What Causes the Neonatal Lung Epithelium To Switch To An Absmentioning

confidence: 99%

“…70 In addition, steroids have been shown to have beneficial effects on the surfactant system as well as pulmonary mechanics. 43,74,111,121,133,134 …”

Section: What Causes the Neonatal Lung Epithelium To Switch To An Absmentioning

confidence: 99%

Elective Cesarean Section: Its Impact on Neonatal Respiratory Outcome

Ramachandrappa¹,

Jain²

2008

Clinics in Perinatology

158

108

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The transition from a fluid filled lung to one filled with air in a very short period of time is one of the biggest challenges a newborn faces after birth. Respiratory morbidity as a result of failure to clear fetal lung fluid is not uncommon, and can be particularly problematic in some infants delivered by elective cesarean section (ECS) without being exposed to labor. The increasing rates of cesarean deliveries in the United States and worldwide, have the potential for a significant impact on public health and health care costs due to the morbidity associated with this subgroup. Whereas the occurrence of birth asphyxia, trauma, and meconium aspiration is reduced by elective cesarean delivery, the risk of respiratory distress secondary to transient tachypnea of the newborn, surfactant deficiency, and pulmonary hypertension is increased. It is clear that physiologic events in the last few weeks of pregnancy coupled with the onset of spontaneous labor are accompanied by changes in the hormonal milieu of the fetus and its mother, resulting in preparation of the fetus for neonatal transition. Rapid clearance of fetal lung fluid is a key part of these changes, and is mediated in large part by transepithelial sodium reabsorption through amiloride-sensitive sodium channels in the alveolar epithelial cells, with only a limited contribution from mechanical factors and Starling forces. In this chapter we discuss the respiratory morbidity associated with ECS, the physiologic mechanisms underlying fetal lung fluid absorption and potential strategies for facilitating neonatal transition when infants are delivered by ECS before the onset of spontaneous labor. The changing landscape for human deliveriesCesarean births rose for an tenth straight year in 2006 to a record 31.1% of all deliveries in the United States; this rate is more than 50% higher than in 1996 and is accompanied by a significant drop in the number of women attempting vaginal birth after a previous cesarean delivery (VBAC). 56 ( Fig. 1) Most of the overall increase can be attributed to the increase in the primary cesarean rates, from 14.6% in 1996 to 20.3% in 2005. This rise in the primary cesarean rate coupled with the decrease in the VBAC rate (7.9% in 2005) means that women who have a primary cesarean section have a greater than 90% chance of having a repeat cesarean section, further increasing the overall cesarean rate in the future. 90 Among the many reasons cited for this increase are older women giving birth, multiple gestations from fertility treatments, as well as the concerns of physicians and mothers about the risks of vaginal birth. Cesarean births in low risk or "no risk" mothers where no medical indication can be identified are on the rise and are often referred to as Cesarean Delivery at Maternal Request (CDMR).Address for Correspondence and Reprints: Lucky Jain, MD, MBA, Professor of Pediatrics & Executive Vice Chairman, Emory University School of Medicine, 2015 Uppergate Drive, Atlanta GA 30322, ljain@emory.edu, 404-727-1471. Coauthor...

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“…The effect of glucocorticoids on the developing kidney has been studied in animal models including: the rat [88][89][90], sheep [91][92][93] and baboon [17,94]. The findings suggest that exposure to glucocorticoids can affect nephron endowment and renal maturation.…”

Section: Glucocorticoidsmentioning

confidence: 99%

Preterm Birth and/or Factors that Lead to Preterm Delivery: Effects on the Neonatal Kidney

Ryan¹,

Black²

2015

J Neonatal Biol

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Preterm birth (defined as birth prior to 37 completed weeks of gestation), occurs in approximately 10% of all births and is one of the leading causes of neonatal morbidity and mortality worldwide. Preterm infants are born at a time when kidney development is still ongoing, and consequently can lead to renal impairment (in both the short-term and long-term), as well as severe glomerular abnormalities in some preterm infants. Since the glomerular abnormalities are not present in all preterm kidneys, this suggests that it is not preterm birth per se that leads to the glomerular abnormalities but may relate to factors associated with the etiology of the premature delivery, or factors in neonatal care. In this review, we provide an overview of what is currently known of how prenatal and postnatal factors can potentially impact on the immature kidneys of infants born preterm.

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Single Dose Fetal Betamethasone Administration Stabilizes Postnatal Glomerular Filtration Rate and Alters Endocrine Function in Premature Lambs

Abstract: 1) fetal betamethasone injection 48 h before delivery stabilizes GFR and significantly alters endocrine function in preterm newborn lambs, and 2) the addition of T4 does not augment betamethasone-induced renal and endocrine responses.

Cited by 38 publications

References 27 publications

Stereological Assessment of Renal Development in a Baboon Model of Preterm Birth

Stereological Assessment of Renal Development in a Baboon Model of Preterm Birth

Elective Cesarean Section: Its Impact on Neonatal Respiratory Outcome

Preterm Birth and/or Factors that Lead to Preterm Delivery: Effects on the Neonatal Kidney

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