title: Prenatal glucocorticoids and exogenous surfactant therapy improve respiratory function in lambs with severe diaphragmatic hernia following fetal tracheal occlusion.
abstract: 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.
authors.affiliation: 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
authors.forename: Marcus G
authors.initials: MG
authors.lastname: Davey
authors.forename: Enrico
authors.initials: E
authors.lastname: Danzer
authors.forename: Uwe
authors.initials: U
authors.lastname: Schwarz
authors.forename: N Scott
authors.initials: NS
authors.lastname: Adzick
authors.forename: Alan W
authors.initials: AW
authors.lastname: Flake
authors.forename: Holly L
authors.initials: HL
authors.lastname: Hedrick
mesh_terms: 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
chemical_list: D001688:Biological Products; D005938:Glucocorticoids; D011663:Pulmonary Surfactants; D001623:Betamethasone; C117342:calfactant