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17Beta-estradiol and progesterone supplementation in extremely low-birth-weight infants
A Trotter1, L Maier, H J Grill
1Section of Neonatology and Pediatric Critical Care Medicine, Children's Hospital, University of Ulm, Germany. andreas.trotter@medizin.uni-ulm.de
Insights
Extremely premature infants experience hormone deprivation after birth. This study shows intravenous supplementation of 17beta-estradiol (E2) and progesterone (P) can maintain crucial intrauterine hormone concentrations, potentially benefiting these vulnerable infants.
Area of Science:
- Neonatalogy
- Endocrinology
- Perinatology
Background:
- Pregnancy involves a 100-fold increase in maternal 17beta-estradiol (E2) and progesterone (P) concentrations, vital for fetal development.
- Abrupt withdrawal of placental E2 and P occurs at birth, with prolonged deprivation in extremely premature infants.
- The consequences of this hormonal deprivation in preterm neonates are largely unknown.
Purpose of the Study:
- To investigate methods for maintaining intrauterine concentrations of E2 and P after birth in extremely premature infants.
- To assess the feasibility of intravenous E2 and P supplementation to replicate prenatal hormonal levels.
Main Methods:
- A phospholipid-stabilized soybean oil emulsion containing E2 and P was administered parenterally to 13 extremely premature infants (median gestational age 26.4 wk).
- Supplementation began within hours of birth and continued for a median of 20 days (up to 6 weeks).
- Dosages were adjusted to maintain target intrauterine plasma concentrations of E2 (2000-6000 pg/mL) and P (300-600 ng/mL).
Main Results:
- Intravenous administration successfully maintained target intrauterine E2 and P plasma concentrations in extremely premature infants.
- Median dosages required were 2.30 mg/kg/d E2 and 21.20 mg/kg/d P.
- Infants in this cohort are part of an ongoing randomized, controlled pilot study evaluating the benefits of this supplementation.
Conclusions:
- Intravenous supplementation with E2 and P is a viable strategy to maintain intrauterine hormone concentrations in extremely premature infants.
- This approach offers a potential method to mitigate the effects of hormonal deprivation in this vulnerable population.
- Further research is warranted through the ongoing pilot study to determine the clinical benefits of E2 and P supplementation.
Abstract:
During pregnancy, 17beta-estradiol (E2) and progesterone (P) plasma concentrations increase up to 100-fold. The fetus is exposed to these increasing amounts of E2 and P. Within 1 d after delivery, E2 and P concentrations fall to nonpregnancy concentrations in the mother and the infant. Extremely premature infants are cut off from the placental supply of E2 and P at a very early developmental stage, and therefore they suffer from this deprivation for a longer period than infants born at term. Nothing is known about the consequences of this deprivation. The purpose of this study was to investigate how intrauterine concentrations of E2 and P could be maintained after birth. In 13 infants with a median gestational age of 26.4 wk (24.1-28.7), a phospholipid-stabilized soybean oil emulsion available for parenteral nutrition that contains different amounts of E2 and P was continuously administered, starting within the first postnatal hours. The supplementation was continued as long as venous access was indicated but not longer than 6 wk (median 20 d, 12-44). To maintain intrauterine plasma concentrations of 2000-6000 pg/mL E2 and 300-600 ng/mL P, 2.30 mg x kg(-1) x d(-1) E2 (1.13-3.42 mg x kg(-1) x d(-1)) and 21.20 mg x kg(-1) x d(-1) P (11.23-27.36 mg x kg(-1) x d(-1)) were needed. We conclude that supplementation of E2 and P to maintain intrauterine concentrations in extremely premature infants is possible intravenously. The infants in this study are enrolled in a randomized, controlled pilot study to evaluate the potential benefits of E2 and P supplementation.