Prenatal glucocorticoids and exogenous surfactant therapy improve respiratory function in lambs with severe diaphragmatic hernia following fetal tracheal occlusion.
Fetal tracheal occlusion (TO) accelerates lung growth and can reverse severe lung hypoplasia associated with diaphragmatic hernia (DH), however, lung compliance (Cl) and respiratory gas exchange remain abnormal. We determined the individual and combined effects of prenatal glucocorticoids (GC) and exogenous surfactant therapy (S) on postnatal pulmonary function in lambs with DH that underwent prolonged TO. DH was created in 22 fetal sheep at 65 d of gestation and TO performed at 110 d. Eleven DH/TO animals received prenatal GC (betamethasone, 0.5 mg/kg) 48 h before delivery; six GC-treated and five non-GC lambs were administered surfactant (Infasurf, 3 mg/kg) at birth. Six sham-operated lambs served as controls. Lambs were delivered at 139 d gestation and ventilated for 2 h. GC or surfactant therapy alone significantly improved respiratory gas exchange, Cl, and ventilatory efficiency index. Total lung capacity was normalized only in DH/TO lambs that received both GC and S.
Davey
Marcus G
MG
The Children's Institute for Surgical Science and the Center for Fetal Diagnosis and Treatment, The Children's Hospital of Philadelphia, PA 19104, USA. daveym@email.chop.edu
Danzer
Enrico
E
Schwarz
Uwe
U
Adzick
N Scott
NS
Flake
Alan W
AW
Hedrick
Holly L
HL
D000818:Animals; D000831:Animals, Newborn; D001623:Betamethasone / Q000627:therapeutic use; D001688:Biological Products / Q000627:therapeutic use; D005260:Female; D005333:Fetus / Q000187:drug effects / Q000473:pathology / Q000601:surgery; D005938:Glucocorticoids / Q000627:therapeutic use*; D006548:Hernia, Diaphragmatic / Q000188:drug therapy* / Q000601:surgery; D008170:Lung Compliance; D008176:Lung Volume Measurements; D011247:Pregnancy; D011659:Pulmonary Gas Exchange; D011663:Pulmonary Surfactants / Q000627:therapeutic use*; D012119:Respiration; D034561:Sheep, Domestic; D014132:Trachea / Q000601:surgery; D014135:Tracheal Stenosis
D001688:Biological Products; D005938:Glucocorticoids; D011663:Pulmonary Surfactants; D001623:Betamethasone; C117342:calfactant