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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hyaline membrane disease is an important factor in the postnatal mortality of prematures. Its pathogenesis is examined. Prematurity, maternal diabetes, and caesarean section are seen as predisposing causes. Delayed biochemical maturation of the lung (shown by a low lecithin-sphyngomyelin ration in the amniotic fluid and probably caused by hypophyseal-adrenal insufficiency) results in an absence of surfactant. Labour stimulates its production by massive release of endogenous cortisol. The part played by betamethasone and other substances in prophylaxis is discussed. It is felt that, at present, the availability of preformed tensioactive factors alone can achieve the decidedly improved prognosis required in so serious a disease.
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PMID:[Recent acquisitions in hyaline membrane disease]. 33 Nov 43

Although recognition of the neonate as an entity deserving special consideration was slow at first, the rise of perinatology to the rank of subspecialty has occurred swiftly over the last 25 years. Considerable improvements in both the quantity and quality of perinatal survival have resulted. The more significant recent advances in selected areas (hemolytic diseases, hyperbilirubinemia, maternal diabetes, hyaline membrane disease, nutrition of the tiny premature neonate, infections, monitoring and mother-child interaction) are discussed, and speculations are made about the next five years.
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PMID:Advances in perinatal care: 1970--1980. 40 87

The amniotic fluid lecithin/sphingomyelin (L/S) ratio was determined in 182 pregnancies complicated by Classes B and C diabetes and in 28 patients with Classes D, F, and R diabetes. These data were retrospectively correlated with the occurrence of the respiratory distress syndrome (RDS) or hyaline membrane disease (HMD). Only four cases of RDS and two cases of HMD were observed in 200 patients with an L/S ratio of 2.0 or greater prior to delivery. This 3 per cent incidence of complications is no higher than that of the nondiabetic population in our institution. Seven of 10 neonates with an antenatal L/S ratio of 1.5 to 1.9 developed RDS. An L/S ratio of 2.0 or more appears to be reliable predictor of fetal pulmonary maturity even in pregnancies complicated by diabetes mellitus.
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PMID:Lecithin/sphingomyelin ratio in pregnancies complicated by diabetes mellitus. 57 62

Hyaline membrane disease or respiratory distress syndrome of prematurely born infants is more common in males, in Caucasians, has a familial predisposition, and is associated with maternal diabetes and delivery by cesarean section before the onset of labor. Now known to be the sequel of surfactant deficiency, it can be predicted prenatally by assay of amniotic liquid for surface active materials produced by the fetal lung. Deficiency of adequate surfactant synthesis or secretion can result in low levels of lecithins and other phospholipids in amniotic liquid. Lung maturation can result in low levels of lecithins and other phospholipids in amniotic liquid. Lung maturation can be accelerated if labor or elective delivery can be deferred at least 24 hours. Glucocorticoids given to the mother cross the placenta and enter fetal lung tissues; specific receptors exist in the lung which permit glucocorticoids to promote cell differentiation and surfactant synthesis precociously. Clinical trials support the efficacy and lack of short-term toxicity of glucocorticoids in human pregnancy after 28 weeks gestation in the event of premature onset of labor. Maternal toxemia, infection or illness which may be aggravated by glucocorticoids may contraindicate prenatal treatment. Postnatally endogenous glucocorticoids accelerate lung maturation, and further administration confers no additional benefit.
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PMID:Chevalier Jackson Lecture: In quest of the prevention of hyaline membrane disease. 57 67

Hyaline membrane disease (HMD) is leading single cause of death of newborn, premature infants. The "hyaline membranes" consist chiefly of fibrin. The clinical manifestation of HMD is the respiratory distress syndrome (RDS). Infants with RDS were treated with urokinase-activated human plasmin in a previous clinical trial. Survival rate was increased in the plasmin treated group as compared to the placebo recipients. However, cost and difficulty in the preparation of the enzyme made this treatment impractical. We, as well as others, have shown the premature infants lack serum plasminogen; thus they are unable to develop effective fibrinolysis and are defenseless against pulmonary fibrin deposition. Therefore, plamsinogen was tested as a possible preventive agent in RDS due to HMD. In a double blind, randomized study, infants between 1 and 2.5 kg birth weight received plasminogen or placebo shortly after birth, and were then followed for development of RDS. After 100 infants were entered into the study, the code was broken and results were evaluated to assure safety of the procedure. Among the 100 infants, 51 received placebo, 49 received plasminogen. Among the infants who received placebo, seven developed mild, and ten developed severe respiratory distress; of these ten, five died with histopathologically documented HMD. Two infants died from causes other than HMD. Among the 49 infants treated with plasminogen, 13 developed mild and three developed severe respiratory distress. There was no death due to HMD. Two deaths were due to other causes. Factors placing the infant at risk from HMD (degree of prematurity, sex, cesarean section, bleeding episodes during pregnancy, maternal diabetes) were found to be evenly distributed between control and treated groups. Since completing the first phase of the study, data of an additional 277 infants has become available. Although the code was not broken in this series, a preliminary look at mortality data in comparison with mortality data of the first series of 100 (in which the code was broken) suggests that preventive activity of plasminogen has been maintained in the second phase of the study.
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PMID:Studies on the prevention of respiratory distress syndrome of infants due to hyaline membrane disease with plasminogen. 79 69

Amniotic fluid lecithin/sphingomyelin (L/S) ratios were determined at least once in 190 pregnancies. In 127 pregnancies an amniotic fluid specimen was obtained within 72 hours of delivery. This constitutes the corrected group. Respiratory distress was encountered 21 times with 13 of these being clinical hyaline membrane disease (CHMD). The remaining cases were either transient respiratory distress or felt to be aspiration pneumonia. When the L/S ratio was positive and the infant delivered vaginally, there was only one case of CHMD. However, when the patients had grave enough disease to warrant cesarean section, CHMD was encountered in seven cases out of 68 cesarean sections. Of the eight cases of CHMD, five were in mothers whose pregnancy was complicated by diabetes mellitus.
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PMID:Amniotic fluid phospholipid analysis in normal and complicated pregnancies. 80 84

In a consecutive series of 600 pregnancies (618 infants) in 300 clinically diabetic patients, treated in Dublin, Ireland, the maternal mortality was 0 and the loss of viable infants was 9.5%. Therapeutic abortion and sterilization were not practiced. The cesarean section rate was 23%. The major causes of perinatal loss were hyaline membrane disease and congenital malformations. Recent routine estimation of the L/S ratio in amniotic fluid led to a reduced incidence of respiratory distress syndrome and a consequent improvement in perinatal mortality. At a very early stage in pregnancy diabetic patients should be referred to a center in which physician, obstetrician, nurse, and pediatrician operate as a team. Strict control of diabetes is essential.
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PMID:Pregnancy complicated by clinical diabetes mellitus. A study of 600 pregnancies. 85 May 62

Dexamethason in a total dose of 15 mg was given in 125 cases of premature labour 48 hours before delivery to prevent the development of respiration distress syndrome. Clinically, the incidence of RDS was 14,5% (18 cases) in the treated group, while in the control group it was 27,7% (32 cases out of 119). Owing to RDS two prematures died in the treated group, and 14 in the control one. Steroid prophylaxis was applied prenatally with 69 pregnant women at term who were predisposed to give birth to infants developing RDS (retardation, diabetes mellitus, elective section caesareas, etc.). Five neonates developed RDS and one died of hyaline membrane disease. The authors studied the effect of steroids on carbohydrate metabolism and total oestrogen excretion in the urine. From profile examinations of blood sugar it was concluded that no pathological alterations take place in maternal carbohydrate metabolism due to intravenous or intermittent prolonged administration of Dexamethason. After one single large dose (15 mg) of Dexamethason a reduction of 30-40% was noted in total oestrogen excretion. Return to the initial value was noted on the 11th-12th day. No appreciable changes were observed with prolonged intermittently given Dexamethason. On the basis of their observations the authors consider that steroid therapy applied during labour is efficient in preventing neonatal RDS.
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PMID:[Prevention of respiratory distress syndrome prior to delivery using steroids]. 89 45

The average estradiol concentrations in umbilical cord plasma from newborns which developed respiratory distress with or without hyaline membrane disease (RDS) were lower by 25% than in controls. Complication of pregnancy by maternal diabetes or pruritus has been associated with abnormalities in estrogen concentrations in the mother, but cord plasma estradiol levels in these cases were essentially normal. Because of reports that treatment of the mother before delivery with estrogens or glucocorticoids results in a decreased incidence of RDS in newborns the relationship between endogenous estradiol and cortisol levels in cord plasm was investigated. There was no significant correlation between the concentrations of these steroids in 65 specimens; the cortisol levels associated with two cases of severe RDS were low.
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PMID:Umbilical cord plasma estradiol levels in relation to complications of pregnancy and newborn and to cortisol levels. 117 1

A delay in the pulmonary maturation of the foetus of diabetic mothers assessed by the lecithin-sphingomyelin (L/S) ratio has been reported (2, 3, 5). A suggestion has been raised that the results of the L/S ratio should be viewed with caution in predicting lung maturity in pregnancies complicated by maternal diabetes (8). We report our findings on 52 insulin-dependent diabetic pregnancies which involved 90 estimations of the L/S ratio on the amniotic fluid. In all cases, the L/S ratio accurately reflected lung maturity, as no hyaline membrane disease (HMD) was observed with a L/S ratio greater than 2. There was no significant difference in the proportion of mature fetal lung between insulin-dependent diabetics and controls for each week of pregnancy between 32 and 38 weeks. There is no statistical difference in the mature L/S ratio between classes B + C and D + F diabetics.
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PMID:[The lecithin-sphynogomyelin ratio in the amniotic fluid in insulin dependent diabetic pregnancies]. 123 Apr 79


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