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Query: UMLS:C0728731 (prematurity)
 7,134 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Chorioamnionitis is the most significant source of prenatal inflammation and preterm delivery. Prematurity and prenatal inflammation are associated with compromised postnatal developmental outcomes, of the intestinal immune defence, gut barrier function and the vascular system. We developed a sheep model to study how the antenatal development of the gut was affected by gestation and/or by endotoxin induced chorioamnionitis.Chorioamnionitis was induced at different gestational ages (GA). Animals were sacrificed at low GA after 2d or 14d exposure to chorioamnionitis. Long term effects of 30d exposure to chorioamnionitis were studied in near term animals after induction of chorioamnionitis. The cellular distribution of tight junction protein ZO-1 was shown to be underdeveloped at low GA whereas endotoxin induced chorioamnionitis prevented the maturation of tight junctions during later gestation. Endotoxin induced chorioamnionitis did not induce an early (2d) inflammatory response in the gut in preterm animals. However, 14d after endotoxin administration preterm animals had increased numbers of T-lymphocytes, myeloperoxidase-positive cells and gammadelta T-cells which lasted till 30d after induction of chorioamnionitis in then near term animals. At early GA, low intestinal TLR-4 and MD-2 mRNA levels were detected which were further down regulated during endotoxin-induced chorioamnionitis. Predisposition to organ injury by ischemia was assessed by the vascular function of third-generation mesenteric arteries. Endotoxin-exposed animals of low GA had increased contractile response to the thromboxane A2 mimetic U46619 and reduced endothelium-dependent relaxation in responses to acetylcholine. The administration of a nitric oxide (NO) donor completely restored endothelial dysfunction suggesting reduced NO bioavailability which was not due to low expression of endothelial nitric oxide synthase.Our results indicate that the distribution of the tight junctional protein ZO-1, the immune defence and vascular function are immature at low GA and are further compromised by endotoxin-induced chorioamnionitis. This study suggests that both prematurity and inflammation in utero disturb fetal gut development, potentially predisposing to postnatal intestinal pathology.
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PMID:Endotoxin induced chorioamnionitis prevents intestinal development during gestation in fetal sheep. 1950 10

Candida albicans produces intestinal perforation and necrotizing enterocolitis (NEC) in preterm newborns. We reviewed pathology files in neonates with a diagnosis of NEC (10-year period), gathered history, and reviewed histological materials. Of 249 autopsies, two (0.8%) had systemic candidiasis. From 66 surgical cases with a diagnosis of NEC, five cases (7.5%) had intestinal candidiasis. Candida albicans grew in pre- and post-mortem blood, lung, or peritoneal fluid in all cases. Histologically, the small bowel revealed fungi, sometimes intravascular. Systemic candidiasis with intestinal involvement is an important complication of prematurity and a prevalent cause of sepsis. The presence of intraluminal fungi with associated vascular occlusion may lead to bowel ischemia, necrosis, and perforation.
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PMID:Intestinal candidiasis: an uncommon cause of necrotizing enterocolitis (NEC) in neonates. 2045 Feb 70

Erythropoietin (Epo) has long been recognised for its role in the control of erythropoiesis and therefore in the treatment of anemia including anemia of prematurity. The erythropoietin receptor (Epo-R) though is expressed in many other organs including the CNS. This review focuses on the role of erythropoietin during the development of the CNS and its potential role as a neuroprotective agent. Epo-R is expressed in many different cellules of the CNS during development including neural progenitor cells, neurons, astrocytes and oligodendrocytes. In the event of hypoxia CNS cells respond with increase of erythropoietin release with subsequent stimulation of neurogenesis through Epo-R on neural progenitor cells. In an Epo-R knock-out model therefore cerebral development is severely impaired. In models of hypoxia-ischemia exogenous Epo has been shown to reduce lesion size and improve structural and functional recovery. Human studies are emerging using Epo as a neuroprotective agent both for the term infant with hypoxia-ischemia as well as for the extremely preterm infant.
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PMID:[Erythropoietin and neuroprotection]. 2072 13

World-wide, many fetuses and infants are exposed to methylxanthines via maternal consumption of coffee and other beverages containing these substances. Methylxanthines (caffeine, theophylline and aminophylline) are also commonly used as a medication for apnea of prematurity.The metabolism of methylxanthines is impaired in pregnant women, fetuses and neonates, leading to accumulating levels thereof. Methylxanthines readily passes the placenta barrier and enters all tissues and thus may affect the fetus/newborn at any time during pregnancy or postnatal life, given that the effector systems are mature.At clinically relevant doses, the major effector system for methylxanthines is adenosine receptors. Animal studies suggest that adenosine receptors in the cardiovascular, respiratory and immune system are developed at birth, but that cerebral adenosine receptors are not fully functional. Furthermore animal studies have shown protective positive effects of methylxanthines in situations of hypoxia/ischemia in neonates. Similarly, a positive long-term effect on lung function and CNS development was found in human preterm infants treated with high doses of caffeine for apneas. There is now evidence that the overall benefits from methylxanthine therapy for apnea of prematurity outweigh potential short-term risks.On the other hand it is important to note that experimental studies have indicated that long-term effects of caffeine during pregnancy and postnatally may include altered behavior and altered respiratory control in the offspring, although there is currently no human data to support this.Some epidemiology studies have reported negative effects on pregnancy and perinatal outcomes related to maternal ingestion of high doses of caffeine, but the results are inconclusive. The evidence base for adverse effects of caffeine in first third of pregnancy are stronger than for later parts of pregnancy and there is currently insufficient evidence to advise women to restrict caffeine intake after the first trimester.
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PMID:Methylxanthines during pregnancy and early postnatal life. 2085 4

Gastric perforation is a potentially fatal condition that is rare in infants and children. Most case reports in the pediatric population are of neonates or in patients with various associated risk factors including prematurity, ischemia, trauma, or ulcers. Heterotaxy syndrome is characterized by abnormal symmetry and malposition of the thoracoabdominal organs and vessels. Spontaneous gastric perforation has not previously been reported in a child with heterotaxy syndrome. We present a case of a child with heterotaxy syndrome who presented with spontaneous gastric perforation. We review the signs and the symptoms, radiographic clues, and diagnostic considerations of gastric perforation.
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PMID:Spontaneous gastric perforation in a child with heterotaxy syndrome. 2113 5

Neonatal brain injury, caused by perinatal hypoxia-ischemia and extreme prematurity, remains a great challenge for prevention and treatment. There is no effective treatment for term hypoxic-ischemic encephalopathy (HIE) except hypothermia which by itself does not afford complete neuroprotection. Erythropoietin (EPO), a pleiotropic cytokine, has neuroprotective effects in a series of neonatal experimental models and recent clinical trials of HIE. However, the mechanisms, dosing, and the toxicity of EPO in these settings are inconsistently reported. This review will focus on the possible mechanisms, recent clinical advances and potential complications of EPO used in research and the clinic. In addition, optimal dose and administrative routes of EPO, and novel EPO mimetics will be discussed.
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PMID:Erythropoietin for neonatal brain injury: opportunity and challenge. 2127 66

The idea of antiangiogenesis as a therapeutic strategy has been around for several decades (1). Vigorously pursued as a novel anticancer strategy (reviewed in (2-6), it is now widely considered to be a promising approach to the treatment of a range of pathologies of which uncontrolled vascular proliferation is a component (see Table 1). To date, therapeutic benefit has been achieved with antiangiogenic therapy in the treatment of life-threatening infantile hemangioma, pulmonary hemangiomatosis, and in the treatment of some vascular tumors (7,8). Table 1 Table 1 Pathologies Likely to Benefit from Therapeutic Intervention in Angiogenesis Excess angiogenesis Insufficient angiogenesis Arthritis Angiology Inflammatory, Vascular malformation Rheumatoid, Hemifacial micromia Kaposi's sarcoma Bone fracture nonunion Leukemia, lymphoma, and myeloma Chronic wounds Macular degeneration Ischemia/infarction Paget's disease Cerebral Psoriasis Intestinal Retinopathy (and its vascular complications) Myocardial Proliferative Peripheral Of prematurity Pyrogenic granuloma Solid carcinomas Ulcer Primary Duodenal Secondary (metastasis) Gastric Vascular tumors Hemangioma Capillary Juvenile (infantile) Hemangiomatosis Hemagioblastoma Other benign vascular proliferations.
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PMID:Therapeutic inhibition of angiogenesis. 2134 Sep 8

The preterm birth has been increasing for the last decade. With the development of neonatal intensive care techniques, the survival rate of preterm infants is increased markedly. However, the brain of preterm infants is so vulnerable to injury that preterm brain injury has become an enormous public health problem. Hypoxia-ischemia and infection/inflammation are two main perinatal risk factors causing premyelinating oligodendrocyte and cortical neuron injury. Encephalopathy of prematurity is characterized by diffuse white matter injury and neuronal/axonal disruption, leading to neurological disabilities such as cognitive impairment and cerebral palsy. The advancement in imaging techniques, especially magnetic resonance imaging, provides more information for preterm brain injury and brain development, which contributes to the diagnosis and follow-up of the preterm infants. This article reviews the progress in encephalopathy of prematurity in order to open a new window to prophylaxis and management of this disease.
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PMID:[Progress in encephalopathy of prematurity]. 2200 Apr 27

Prematurity and perinatal hypoxia-ischemia are common problems that result in significant neurodevelopmental morbidity and high mortality worldwide. The Vannucci model of unilateral brain injury was developed to model perinatal brain injury due to hypoxia-ischemia. Because the rodent brain is altricial, i.e., it develops postnatally, investigators can model either preterm or term brain injury by varying the age at which injury is induced. This model has allowed investigators to better understand developmental changes that occur in susceptibility of the brain to injury, evolution of brain injury over time, and response to potential neuroprotective treatments. The Vannucci model combines unilateral common carotid artery ligation with a hypoxic insult. This produces injury of the cerebral cortex, basal ganglia, hippocampus, and periventricular white matter ipsilateral to the ligated artery. Varying degrees of injury can be obtained by varying the depth and duration of the hypoxic insult. This chapter details one approach to the Vannucci model and also reviews the neuroprotective effects of erythropoietin (Epo), a neuroprotective treatment that has been extensively investigated using this model and others.
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PMID:Erythropoietin as a neuroprotectant for neonatal brain injury: animal models. 2345 65

We studied a model of hemorrhagic encephalopathy of prematurity (EP) that closely recapitulates findings in humans with hemorrhagic EP. This model involves tandem insults of 20 min intrauterine ischemia (IUI) plus an episode of elevated venous pressure induced by intraperitoneal glycerol on post-natal day (P) 0. We examined Sur1 expression, which is upregulated after focal ischemia but has not been studied after brief global ischemia including IUI. We found that 20 min IUI resulted in robust upregulation of Sur1 in periventricular microvessels and tissues. We studied tandem insult pups from untreated or vehicle-treated dams (TI-CTR), and tandem insult pups from dams administered a low-dose, non-hypoglycemogenic infusion of the Sur1 blocker, glibenclamide, for 1 week after IUI (TI-GLIB). Compared to pups from the TI-CTR group, pups from the TI-GLIB group had significantly fewer and less severe hemorrhages on P1, performed significantly better on the beam walk and accelerating Rotarod on P35 and in tests of thigmotaxis and rapid learning on P35-49, and had significantly greater body and brain weights at P52. We conclude that low-dose glibenclamide administered to the mother at the end of pregnancy protects pups subjected to IUI from post-natal events of elevated venous pressure and its consequences.
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PMID:The protective effect of glibenclamide in a model of hemorrhagic encephalopathy of prematurity. 2366 41


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