Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0029713 (immaturity)
 4,335 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Diseases which manifest with the respiratory distress in the newborn include 1) respiratory diseases-IRDS, type II RDS, neonatal asphyxia, and MAS etc. 2) anemia, CHD 3) CNS and 4) metabolic diseases. Among these, IRDS has high mortality rate because of the lack of the pulmonary surfactant and immaturity of respiratory center, and has many difficult problems in terms of its prevention and respiratory management. The points of its respiratory management are as follows: 1) Estimation of the level of arterial oxygen ation-this is the most important point. It has become possible, these days, to monitor continuous oxygenation using a transcutaneous oxygen electrode. 2) Knowledge of the physiology & management of apnea, and monitoring of heart rate and respiration. 3) Correction of acidosis & anemia and the nutritional supply by the intraveonous fluid administration. 4) Airway maintenance. 5) Oxygen administration to main PaO2 or tc PO2 of 60--80 mmHg. 6) Artificial ventilation by CPAP or IMV and 7) The specific drug therapy includes indomethacin for PDA associated with IRDS, Tolazoline for the fetal circulation syndrome, and Xanthine derivatives for primary apnea. 8) However, improvement by exchange transfusion has been contro-versial. On the other hand, in the type II RDS which has a relatively good prognosis, the intact survival can be expected by means of the proper management of general condition and respiration. In MAS, pneumothorax, pneumomediastinum and severe asphyxia, the proper resuscitation, oxygen administration should be given according to several conditions, especially the degree of hypoxia. The peritoneal dialysis can be lifesaving in case of severe renal impairment with RD. As the respiratory distress in the newborn is very frequent in its occurrence and death rate, its proper management is expected to result in the decrease in the newborn death rate in Hokkaido (8.1--6.6 per 1,000 live births) and the increase in the survival rate without any handicap, particularly if hospitals in each Hokkaido district give the newborn medical care more intensively than at present.
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PMID:[Respiratory distress in the newborn (author's transl)]. 39 87

A new test for the evaluation of fetal lung maturity, called tap test, been recently developed. This rapid, inexpensive, and reliable test is easy to perform and can be used whenever testing for phospholipids are not available. We performed this test in 260 clear samples of amniotic fluid obtained by transabdominal amniocentesis and the results were compared with those of the "shake test". When the "shake test" was positive (n = 156), the tap test was consistent with fetal lung maturity in all cases. When the "shake test" was intermediate or negative (n = 61 and n = 43, respectively), the tap test was consistent with immaturity in only 19.2% of the cases. Fifty-four fetuses were born within 72 hours after the amniocentesis. The "shake test" was positive in 50, intermediate in 3, and negative in 1. In all but one of there cases the tap test was consistent with maturity. The only case of RDS in this series occurred in an infant with immature result. These findings indicate that the tap test is a reliable indicator of fetal pulmonary maturity and probably with a higher specificity than the "shake test".
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PMID:[The tap test in the rapid evaluation of fetal lung maturity]. 134 25

Surfactant is now available for general clinical use in infants with RDS. While surfactant is effective, it does not prevent lung disease in many preterm infants because of other aspects of lung immaturity. In experimental models, corticosteroids alter the fetal lung by improving compliances, increasing lung volumes, decreasing pulmonary edema, and altering surfactant-compliance dose response curves. These effects are independent of changes in surfactant pools but augment the responses of the lungs to surfactant treatment. Optimal outcomes for the preterm require the combined use of fetal maturation strategies and postnatal surfactant.
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PMID:Surfactant in the perinatal period. 139 80

The determination of lecithin or even more the lecithin/sphingomyelin (L/S) ratio in amniotic fluid are both well established in the prediction of neonatal RDS. The immunological measurement of phosphatidylglycerol (PG) and the determination of the surfactant/albumin (S/A) ratio by fluorescence polarization (TDx FLMR) have recently been introduced for the detection of fetal lung maturity. In order to compare traditional versus recent methods L/S ratio and PG determination by one dimensional thin-layer chromatography, enzymatic analysis of lecithin, immunological determination of PG by Amniostat-FLMR and the fluorescence polarization of S/A-ratio by the TDx FLMR were all performed in 141 amniotic fluid samples of 122 patients. Only one out of 72 samples was false negative in the enzymatic lecithin determination (sensitivity 88%). All other methods have a sensitivity and a negative predictive value of 100%. The positive predictive values and the specificity varied between 22%-50% and 58%-87% respectively. The false positive rate, which is high for all methods, is lowest for the L/S ratio. This study demonstrates, that the recent methods are reasonable alternatives in all cases with a positive test. In clinical practice they have the advantage, that the result can be obtained in 15 minutes. If the test is predictive for lung immaturity the L/S ratio should be performed in addition to decrease the false positive rate before any clinical decision is made.
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PMID:Prediction of RDS by amniotic fluid analysis: a comparison of the prognostic value of traditional and recent methods. 147 17

Respiratory distress syndrome (RDS) is primarily caused by an immaturity in the synthesis and secretion of surfactant by the fetal lung type II cell. Fetal hyperinsulinemia associated with maternal diabetes places the newborn at an increased risk of developing RDS, and therefore, it has been hypothesized that insulin inhibits type II cell differentiation. We have previously shown that insulin inhibits the accumulation of surfactant-associated protein A (SP-A), the major surfactant-associated protein, in human fetal lung explants maintained in vitro. In the present study, we used Northern blot analysis to evaluate the effects of insulin on the content of SP-A messenger RNA (mRNA) as well as on the content of mRNA for the hydrophobic surfactant-associated proteins SP-B and SP-C in human fetal lung explants maintained in vitro. Lung explants were maintained in serum-free medium with or without added insulin (0.25-2500 ng/ml) for up to 6 days. We observed that insulin, at concentrations of 25-2500 ng/ml, significantly inhibited the accumulation of SP-A mRNA when compared to controls (P less than 0.01). The inhibitory effect of insulin on SP-A mRNA accumulation was dose dependent with an approximately 75% inhibition observed at 2500 ng/ml. Insulin, at the concentration of 2500 ng/ml, significantly inhibited the accumulation of SP-B mRNA by approximately 30% when compared to control levels (P less than 0.01) but had no effect at lower concentrations. Insulin had no significant effect on SP-C mRNA levels at any concentration tested. Our findings provide evidence that insulin may delay fetal lung development by inhibiting SP-A and SP-B gene expression. A deficiency of these proteins in pulmonary surfactant may account for the increased incidence of RDS in infants of diabetic mothers.
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PMID:Insulin regulation of messenger ribonucleic acid for the surfactant-associated proteins in human fetal lung in vitro. 163 13

The consequences of a preterm birth are usually not secondary to a developmental abnormality but rather due to the immaturity of one or more organ systems. Because neonatal RDS is the most common and the most severe complication of a preterm delivery, a major emphasis has been placed on its prevention and/or treatment. Despite intensive research efforts directed at preventing or inhibiting preterm labor, to date there is no universally effective method that can be used in most patients. As a result, preterm birth will continue to occur and continue to challenge the health care provider. Several medications and hormones have been shown to stimulate endogenous surfactant production in the fetus. Their administration to women at risk of delivering preterm can decrease both the incidence and severity of neonatal RDS. The primary limiting factor with most agents is the need to delay birth for 48 to 72 hours to achieve maximum therapeutic effect. This mandates the obstetric health care provider not only identify parturients who will deliver preterm but also manage their intrapartum course to achieve maximum value from these pharmacologic agents. Lastly, in those patients in whom labor can be neither inhibited nor safely delayed, exogenous surfactant therapy offers real hope particularly to the very low birth weight baby. To obtain maximum benefit in the very premature infant, i.e., less than 30 weeks' gestation, therapy ideally should begin immediately after birth and before the first breath. However, to offer such therapy, patients need to be identified during the intrapartum period.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pharmacologic induction of fetal lung maturity. 186 39

Despite all the progress made in modern neonatology the morbidity rate caused by bacterial infections has rather gone up than down. The reasons why premature and newborn infants have a greater disposition to bacterial infections have been largely explored; at the same time one must accept these infants to be increasingly vulnerable to infections, the vulnerability being the larger the greater the degree of immaturity is. Every 5th to 10th death of newborn infants is caused by infection. One will have to be constantly on the watch and acquire profound knowledge of channels of infection and the bacterial spectrum to be expected. Since the early beginnings of neonatology, some 60 years ago, a continuous change in bacterial spectra has been going on showing incredible regularity in crossing even borders and continents. With gram-positive cocci (A streptococci) prevailing at the beginning, there was a considerable increase in gram-negative enterobacteriaceae in the 60ies and 70ies, when neonatal intensive medicine was started. There were mainly nosocomial infections resulting from too generously administered antibiotics. Today, plasmacoagulase-negative staphylococci, for a long period thought not to be pathogenous, are the essential bacteria in nosocomial infections. On the whole, one usually has to do with infections vertically transmitted by the mother, especially to preterm infants. The greatest threat still comes from B streptococci since they will lead to pulmonary changes such as pneumonia and RDS. The development reported on is based on data from the literature and my own experience as well as on comprehensive results of the Neonatalerhebung of Lower Saxony and Bavaria.
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PMID:[Causes of and change in bacterial infections in newborn infants]. 192 72

Neonatal mortality and causes of death at King Fahd Hospital of the University in Al Khobar, Saudi Arabia from June 1981 to May 1986 were analyzed to assess the quality of and to formulate plans to improve perinatal health care. All liveborn infants weighing 500 g or more delivering at King Fahd Hospital were included. The uncorrected neonatal mortality risk ratio (NNMR) declined by 32% between the 1st and 2nd years and 48% and 60%, reductions occurred in crude and standardized mortality, respectively, from the 1st year to the end of the 5th. The incidence of low birth weight (LBW) averaged 7.1% and failed to change during the 5 years. The was a significant variation in the incidence of very low birth weight rate (VLBWR). The lowest rate of 0.38% occurred in 1982-83 during the 2nd year and was significantly different from the rates in all other years, except 1983-82, the mortality rate for infants weighing 1500 g or less was significantly reduced in 1983-84 and 1984-86. After establishment of the neonatal intensive care unit (NICU), there was a modest reduction in the crude NNMR from 12.4 to 9.4 and a significant decline in the standardized NNMR. Similarly, the NNMR/VLBWR ratios were 1.94 and 0.96, respectively, before and after the introduction of the NICU. Congenital malformations, RDS, and asphyxia were the 3 most common causes of death. These conditions and severe immaturity account for 74% of deaths.
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PMID:Neonatal vital statistics: a 5-year review in Saudi Arabia. 246 Nov 58

2216 newborns and prematures with respiratory distress of different underlying diseases were treated with long term respiratory therapy from 1. Jan. 1975 to 31. Dec. 1985. One part of the patients were born in our hospital, the other part of them were transported from outside. The rate of prematures was 81.2%. The respiratory therapy was applied in 1813 cases because of pulmonary diseases (group 1.), while in 403 cases the respiratory troubles were extrapulmonary in origin (group 2.). The diseases in the first group were as follows: hyaline membrane disease in 482 cases (27.30%), intrauterine pneumonia in 634 cases (34.64%), postnatal pneumonia in 291 cases (15.90%), meconium aspiration syndrome in 110 cases (6.01%), severe RDS-II in 158 cases (8.63%), pulmonary immaturity in 116 cases (6.35%), persistent fetal circulation in 21 cases (1.15%) and pulmonary aplasia on the left in 1 case (0.021%). In the second group the greatest part of the cases were treated for neurological disturbances. We discuss the indications of different types of respiratory therapy and the complications as well. The survival rate was in the first group 59.3%, while in the second only 16.9%. Therefore the respiratory therapy seems to be more effective in the pulmonary diseases of the newborns. The mortality rate and the rate of severe complications were lower among inborn babies because of the early application of the respiratory therapy.
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PMID:[Continuous respiratory therapy of newborn and premature infants with respiratory disorders]. 277 89

Main indications for antenatal administration glucocorticoid to pregnant women are premature contractions, hemorrhage during pregnancy, conditions of fetal distress and maternal diseases. There are some absolute or relative contraindications as well: severe forms of preeclampsia, diabetes mellitus, premature rupture of membranes, maternal and/intrauterine infections. In a retrospective evaluation of the data obtained at our institution of 637 nonrandomized cases from the years 1980-1985, we could demonstrate the dependence of the therapeutic results on the sex of the newborn. The RDS incidence is significantly different after betamethasone prophylaxis. It was 1/25 (4%) in girls compared to 13/31 (42%) in boys. A marked reduction of the RDS incidence is only detectable after betamethasone therapy from the 32nd to the 34th week of gestation. Thus we recommend RDS prophylaxis for all patients with premature contraction, mainly between the 32nd and 34th week of pregnancy. In addition, it should be given in cases of confirmed lung immaturity. Special restrictions are necessary in cases of preeclampsia, eclampsia, diabetes and confirmed maternal infections. In the group of diabetes or preeclampsia patients an RDS prophylaxis should only be given, if at all, when it can be performed under intensive care conditions.
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PMID:Clinical aspects of antenatal glucocorticoid treatment for prevention of neonatal respiratory distress syndrome. 344 99


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