The replacement of oestradiol and progesterone in very premature infants.
The idea of replacing 17beta-oestradiol (E2) and progesterone (P) in preterm infants is based on the observation that during pregnancy E2 and P plasma concentrations rise in the mother and the fetus by a factor of 100. Disruption of the placental supply of these hormones is a physiological event for an infant delivered at term. A preterm infant is deprived from this supply at an earlier developmental stage. In vitro and in vivo data are discussed, and they highlights the potential benefit of E2 and P on the development of different organ systems. The postnatal replacement of E2 and P has the aim of maintaining in utero plasma concentrations. In the first randomized clinical study in 30 extremely preterm infants, E2 and P were replaced postnatally for a total of 6 weeks. With a median intravenous replacement of 8.4 micromol/kg/day of E2 (4.2-22.9) and 67.4 micromol/kg/day of P (35.7-87.0), plasma levels of E2 and P were maintained within the intrauterine reference values of 7.3-22.0 nmol/L and 0.95-1.9 micromol/L, respectively. Three- to sixfold higher dosages were needed via the transepidermal route. Trends towards an improved postnatal bone mineral accretion and a reduced incidence of chronic lung disease were found. Further studies are warranted to clarify the potentially important role of E2 and P for the postnatal development of an extremely preterm infant.
Trotter
A
A
Section of Neonatology and Pediatric Critical Care Medicine, Children's Hospital, University of Ulm, Germany. andreas.trotter@medizin.uni-ulm.de
Pohlandt
F
F
D001921:Brain / Q000187:drug effects / Q000254:growth & development; D002113:Calcification, Physiologic / Q000187:drug effects; D004958:Estradiol / Q000097:blood / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008168:Lung / Q000187:drug effects / Q000254:growth & development; D008297:Male; D011247:Pregnancy; D011374:Progesterone / Q000097:blood / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic
D011374:Progesterone; D004958:Estradiol