title: FGR in the setting of preterm sterile intra-uterine milieu is associated with a decrease in RDS.
abstract: To determine if fetal growth restriction (FGR) in the setting of sterile intra-uterine milieu would be associated with a decrease in respiratory distress syndrome (RDS) of preterm-neonates.
  
  
  
  The relationship between FGR and neonatal RDS was examined in 92 singleton preterm-neonates (gestational age [GA]: 24.5-33.4 weeks) born to mothers with sterile intra-uterine milieu, which consisted of both sterile amniotic fluid (AF), and inflammation-free placenta. Sterile AF was defined in the absence of both infection and inflammation in AF. AF inflammation was defined in the presence of AF MMP-8 ≥23 ng/ml. FGR was defined in the presence of birth-weight (BW) below the 5th percentile for GA.
  
  
  
  FGR was present in 32% and RDS was found in 46% of patients. RDS was less common (24% vs. 56%; P < 0.01) and umbilical arterial pH at birth ≤7.15 was more common (33% vs. 13%; P < 0.05) in preterm-neonates with FGR than in those without FGR. There is a stepwise increase in RDS with increasing BW (i.e., below the 5th percentile, the 5th ∼10th percentile, and above the 10th percentile for GA) (P < 0.01, linear by linear association). Logistic regression analysis demonstrated that FGR was a better independent predictor of a decrease in RDS (OR = 0.049, 95%CI 0.009-0.259, P < 0.0005) than advanced GA at delivery (OR = 0.584, 95%CI 0.423-0.806, P < 0.005) after adjusting for other confounding variables.
  
  
  
  FGR in the setting of sterile intra-uterine milieu is associated with a decrease in RDS of preterm-neonates. This observation suggests that chronic intra-uterine hypoxic stress related to FGR may be beneficial to fetal lung maturation. Pediatr Pulmonol. 2016;51:812-819. © 2015 Wiley Periodicals, Inc.
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chan-Wook
authors.initials: CW
authors.lastname: Park
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Joong Shin
authors.initials: JS
authors.lastname: Park
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jong Kwan
authors.initials: JK
authors.lastname: Jun
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Bo Hyun
authors.initials: BH
authors.lastname: Yoon
mesh_terms: D000328:Adult; D000653:Amniotic Fluid / Q000502:physiology*; D002821:Chorioamnionitis / Q000503:physiopathology; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis / Q000503:physiopathology*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000209:etiology*
keywords: amniotic fluid; fetal growth restriction; placenta; preterm birth; respiratory distress syndrome