Role of Insulinlike Growth Factor 1 in Fetal Development and in the Early Postnatal Life of Premature Infants.
The neonatal period of very preterm infants is often characterized by a difficult adjustment to extrauterine life, with an inadequate nutrient supply and insufficient levels of growth factors, resulting in poor growth and a high morbidity rate. Long-term multisystem complications include cognitive, behavioral, and motor dysfunction as a result of brain damage as well as visual and hearing deficits and metabolic disorders that persist into adulthood. Insulinlike growth factor 1 (IGF-1) is a major regulator of fetal growth and development of most organs especially the central nervous system including the retina. Glucose metabolism in the developing brain is controlled by IGF-1 which also stimulates differentiation and prevents apoptosis. Serum concentrations of IGF-1 decrease to very low levels after very preterm birth and remain low for most of the perinatal development. Strong correlations have been found between low neonatal serum concentrations of IGF-1 and poor brain and retinal growth as well as poor general growth with multiorgan morbidities, such as intraventricular hemorrhage, retinopathy of prematurity, bronchopulmonary dysplasia, and necrotizing enterocolitis. Experimental and clinical studies indicate that early supplementation with IGF-1 can improve growth in catabolic states and reduce brain injury after hypoxic/ischemic events. A multicenter phase II study is currently underway to determine whether intravenous replacement of human recombinant IGF-1 up to normal intrauterine serum concentrations can improve growth and development and reduce prematurity-associated morbidities.
Department of Ophthalmology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
Ann
A
Hellström
Department of Pediatrics, Institute of Clinical Sciences, Lund University and Skane University Hospital, Lund, Sweden.
David
D
Ley
Department of Pediatrics, Institute of Clinical Sciences, Lund University and Skane University Hospital, Lund, Sweden.
Ingrid
I
Hansen-Pupp
Department of Neonatology, Karolinska Institute and University Hospital, Stockholm, Sweden.
Boubou
B
Hallberg
Genova Neonatal Intensive Care Unit, Instituto Pediatrico Giannina Gaslini, Genova, Italy.
Luca A
LA
Ramenghi
Department of Ophthalmology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
Chatarina
C
Löfqvist
Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Lois E H
LE
Smith
Department of Ophthalmology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
Anna-Lena
AL
Hård
D001997:Bronchopulmonary Dysplasia / Q000097:blood; D002543:Cerebral Hemorrhage / Q000097:blood; D020345:Enterocolitis, Necrotizing / Q000097:blood; D005260:Female; D047109:Fetal Development; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000097:blood* / Q000254:growth & development*; D007334:Insulin-Like Growth Factor I / Q000032:analysis / Q000378:metabolism*; D011247:Pregnancy; D012178:Retinopathy of Prematurity / Q000097:blood; D014470:Umbilical Cord
D007334:Insulin-Like Growth Factor I