Lung physiological and metabolic changes in lambs with congenital diaphragmatic hernia after administration of prenatal maternal corticosteroids.
OBJECTIVE
Improved outcomes of preterm infants born to mothers treated prenatally with corticosteroids have been documented. The authors investigated the role of prenatal maternal corticosteroid therapy in congenital diaphragmatic hernia (CDH).


METHODS
Five CDH lambs of ewes given 0.5 mg/kg betamethasone intravenously 24 hours before delivery (single-dose), four CDH lambs of ewes similarly dosed at 48 and 24 hours before delivery (double-dose), five untreated CDH lambs and five control lambs were studied. After 2 hours of ventilation, compliance, arterial oxygen (PO2) and carbon dioxide (pCO2) concentrations were recorded. Lavage protein and phospholipid levels were measured, and lung tissue was analyzed for antioxidant enzyme activity (AOE).


RESULTS
No improvement in gas exchange was noted in either treatment group. Significant increases in compliance (P = .02) were noted in the double-dose steroid group, which were different from that of untreated CDH lambs or controls. Minimal changes in AOE activities were seen with steroid administration.


CONCLUSIONS
Although the metabolic changes were not significant, the marked improvement in compliance seen in the double-dosed steroid group suggests a potential role for prenatal maternal corticosteroids in CDH. Further timing and dosage studies are warranted in this model.
The Buffalo Institute of Fetal Therapy, Children's Hospital of Buffalo, and the Department of Pediatric Surgery, State University of New York at Buffalo, School of Medicine and Biomedical Sciences, 14222, USA.
P
P
Kapur
B A
BA
Holm
M S
MS
Irish
J
J
Sokolowski
A
A
Patel
P L
PL
Glick
D000818:Animals; D000831:Animals, Newborn; D001623:Betamethasone / Q000008:administration & dosage / Q000494:pharmacology*; D001784:Blood Gas Analysis; D002374:Catalase / Q000378:metabolism; D005260:Female; D005333:Fetus; D005938:Glucocorticoids / Q000008:administration & dosage / Q000494:pharmacology*; D005979:Glutathione Peroxidase / Q000378:metabolism; D006548:Hernia, Diaphragmatic / Q000188:drug therapy*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D008168:Lung / Q000187:drug effects* / Q000201:enzymology* / Q000378:metabolism; D011247:Pregnancy; D011659:Pulmonary Gas Exchange; D012756:Sheep; D013482:Superoxide Dismutase / Q000378:metabolism
D005938:Glucocorticoids; D001623:Betamethasone; D002374:Catalase; D005979:Glutathione Peroxidase; D013482:Superoxide Dismutase