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Glucocorticoids, sodium transport mediators, and respiratory distress syndrome in preterm infants

Liina Süvari1,2, Otto M Helve1, M Anneli Kari1

  • 1Children's Hospital, Pediatric Research Center, Helsinki University and Helsinki University Hospital, Helsinki, Finland.

Pediatric Research
|July 15, 2020
PubMed

Insights

Lower concentrations of antenatal glucocorticoids (GCs) in cord blood are linked to respiratory distress syndrome (RDS) in preterm infants. Airway gene expression of sodium transporters correlates with GC levels, suggesting a role in lung liquid absorption.

Area of Science:

  • Neonatal Medicine
  • Pulmonary Biology
  • Endocrinology

Background:

  • Antenatal glucocorticoids (GCs) are known to reduce respiratory distress syndrome (RDS) in preterm infants.
  • GCs are associated with decreased lung liquid content, suggesting a role in pulmonary fluid balance.
  • The relationship between cord blood GC concentrations and specific airway gene expression related to lung liquid absorption requires further investigation.

Purpose of the Study:

  • To investigate the association between cord blood glucocorticoid (GC) concentrations and airway gene expression of pulmonary epithelial sodium and liquid absorption mediators.
  • To determine if these gene expression levels and respiratory morbidity correlate with antenatal GC levels.

Main Methods:

  • Quantified cortisol and betamethasone in umbilical cord blood of 64 infants delivered before 32 weeks gestation using liquid chromatography-tandem mass spectrometry.
  • Measured gene expression of the epithelial sodium channel (ENaC), Na,K-ATPase, and serum- and GC-inducible kinase 1 in nasal epithelial cells within 2 hours and at 1 day postnatally.
  • Calculated mean oxygen supplementation during the first 72 hours of life.

Main Results:

  • Infants with RDS had significantly lower betamethasone and total GC concentrations in cord blood, which correlated with higher oxygen supplementation needs.
  • Expression of αENaC and α1-, β1Na,K-ATPase at <2 hours postnatally correlated with betamethasone and total GC concentrations.
  • Na,K-ATPase expression was lower in infants diagnosed with RDS.

Conclusions:

  • Lower umbilical cord blood GC concentrations are associated with RDS and reduced airway expression of sodium transporters.
  • The concentration of GCs, in addition to the timing of antenatal treatment, may be crucial for preventing RDS.
  • Induction of sodium transport is a potential mechanism contributing to the pulmonary effects of antenatal GCs.
Abstract

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