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Hormonal modulation of fetal pulmonary development: relevance for the fetus with diaphragmatic hernia
R Keijzer1, M van Tuyl, D Tibboel
1Department of Pediatric Surgery, Sophia Children's Hospital, Erasmus Medical Centre Rotterdam, Dr Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands.
Insights
Antenatal hormonal therapies can reduce respiratory distress syndrome in preterm infants. Further research is exploring their role in congenital diaphragmatic hernia treatment.
Area of Science:
- Neonatal Medicine
- Developmental Biology
- Pulmonary Medicine
Background:
- Antenatal hormonal modulation, particularly glucocorticoids, is clinically used to improve lung development and reduce respiratory distress syndrome (RDS) in preterm infants.
- Potential adverse effects necessitate caution regarding repeated courses of antenatal glucocorticoids.
- Thyroid hormones show synergistic effects with corticosteroids on pulmonary development in animal models, but clinical evidence is lacking.
Purpose of the Study:
- To review the current status of antenatal hormonal modulation for pulmonary growth.
- To discuss the potential application of these therapies in managing congenital diaphragmatic hernia (CDH).
Main Methods:
- Review of existing literature on antenatal hormonal modulation and pulmonary development.
- Discussion of experimental findings and clinical trial data.
- Exploration of potential therapeutic strategies for CDH.
Main Results:
- Antenatal hormonal therapies are established for RDS prevention.
- In utero tracheal occlusion and hormonal therapies are being investigated for CDH, but lack a firm scientific basis.
- A multi-center clinical trial is planned to further evaluate antenatal hormonal modulation.
Conclusions:
- Antenatal hormonal modulation is a key strategy for improving neonatal lung health.
- Further investigation is required to establish the efficacy and safety of hormonal therapies for CDH.
- Upcoming clinical trials are expected to provide critical data on antenatal hormonal modulation's role in CDH treatment.
Abstract:
Antenatal hormonal modulation of pulmonary growth has been successfully introduced in clinical practice to reduce the incidence of respiratory distress syndrome (RDS) of preterm born infants. However, a certain amount of reserve to repeat courses should be taken into account because of possible adverse effects of antenatal administration of glucocorticoids. Although in experimental animals thyroid hormones given alone were not shown to have stimulatory effects on pulmonary development, there was an apparent synergistic effect with corticosteroids. Yet, such effects have not been substantiated in clinical trials. Whereas in cases of congenital diaphragmatic hernia (CDH) in utero tracheal occlusion could stimulate fetal lung growth and modulation, the enhancement of type II cell differentiation is more likely to be achieved with antenatal exposure to hormonal therapies. However, there is still no firm scientific basis for either of these two treatment modalities in CDH. Yet, antenatal hormonal modulation is now soon to be tested in an extensive multi-center clinical trial. In this review, the current status of antenatal hormonal modulation of pulmonary growth will be described and its potential role in the treatment of CDH will be discussed.