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Lung development and function in preterm infants in the surfactant treatment era

A H Jobe1, M Ikegami

  • 1Pulmonary Biology/Neonatology, Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. JOBEAO@CHMCC.ORG

Annual Review of Physiology
|June 9, 2000
PubMed

Insights

Advances in neonatal care have reduced infant mortality for low birth weight infants. However, chronic lung disease remains a challenge, with new research questioning traditional views on lung development and glucocorticoid treatments.

Area of Science:

  • Neonatal Medicine
  • Pulmonary Biology
  • Developmental Pediatrics

Background:

  • Neonatal intensive care advances have decreased mortality in infants under 1-kg birth weight.
  • Despite improved survival, many extremely preterm infants develop chronic lung disease, marked by impaired lung development and alveolarization.
  • Current understanding of antenatal glucocorticoid effects on lung maturation is being re-evaluated based on new experimental data.

Purpose of the Study:

  • To investigate the mechanisms underlying chronic lung disease in very preterm infants.
  • To explore the role of antenatal glucocorticoids and proinflammatory cytokines in lung development and injury.
  • To examine potential differences in lung injury mechanisms between developing and adult lungs.

Main Methods:

  • Review of recent findings from transgenic and experimental models.
  • Analysis of clinical data on surfactant, antenatal glucocorticoid treatments, and ventilation strategies.
  • Investigation of the impact of antenatal proinflammatory exposures and postnatal injury on lung development.

Main Results:

  • Traditional explanations for antenatal glucocorticoid effects on developing lungs are insufficient.
  • Very preterm infants' lungs are vulnerable to ventilation-induced injury due to small gas volumes and delicate tissue.
  • Proinflammatory cytokines may influence both lung development and injury, with potential unique mechanisms in the developing lung.

Conclusions:

  • Chronic lung disease in very preterm infants necessitates a deeper understanding beyond current therapeutic paradigms.
  • Further research into the complex interplay of inflammation, glucocorticoids, and mechanical ventilation is crucial for improving outcomes.
  • Investigating developmental-specific mechanisms of lung injury is essential for targeted therapeutic strategies.

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