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

The levels of hormones of melatonin (MT), ACTH, aldosterone (AS) and cortisol were investigated in the blood plasma of mature and premature newborns as well as in foremilk and milk of lactating women using a radioimmunoassay. Maximum concentrations of these hormones in mature infants were noted by the 1st-3rd day, decreasing on the 5th-7th day. The same regularity was observed in premature infants (I-II degree of prematurity). Lower concentrations of these hormones were observed in very premature infants. A conclusion has been made that breast milk is an important link between a mother and an infant in terms of supplying infants with lactogenic hormones.
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PMID:[Hormones of the hypophyseo-adrenal system and their role in postnatal adaptation of newborns]. 178 20

Changes in circulating steroid hormones, the incidence of myometrial contractions, and the onset of labour were all monitored after administration of the 3 beta-hydroxysteroid dehydrogenase inhibitor, epostane, to chronically catheterized ewes and fetuses near term. In all animals the drug induced delivery 33-36 h after injection or infusion into the ewe with the birth of live healthy lambs which showed normal subsequent development. Epostane induced immediate, permanent falls in both maternal and fetal plasma progesterone concentrations, accompanied by increased PGF metabolite concentrations in the uterine vein beginning 15 min after treatment. Of the other hormonal changes observed, the most striking was the pronounced drop in both maternal and fetal plasma cortisol. In the fetus this fall was followed by increasing concentrations of circulating ACTH which eventually restored the cortisol levels. By 12-24 h after epostane a substantial overshoot had occurred and at 27-30 h the fetal plasma cortisol concentrations were as high as those seen during normal parturition at term. No significant changes in maternal plasma oestradiol-17 beta could be detected after epostane treatment or during labour. The incidence of slow myometrial contractions increased significantly during the second 3-h period after epostane, although their duration did not change. Contraction patterns typical of first stage labour were seen from 20 to 24 h. These results show that epostane may be used as a safe, predictable inducing agent in sheep if given 6-10 days before term; the lambs showed no signs of prematurity despite their lowered plasma cortisol concentrations which persisted for some hours before labour was induced.
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PMID:Effects on maternal and fetal steroid concentrations of induction of parturition in the sheep by inhibition of 3 beta-hydroxysteroid dehydrogenase. 283 51

Neonatal endocrine status was studied in 14 lambs born 7 days before term, after estrogen injection into the ewes, and in 15 full-term animals. Plasma cortisol and triiodothyronine (T3) levels were depressed during the first hours of life in preterm lambs and plasma reverse T3 levels were significantly higher than in controls. The rise in plasma cortisol levels after Synacthen injection was significantly lowered by prematurity, suggesting reduced sensitivity of the adrenal cortex to ACTH. After ovine TSH injection, plasma thyroxine (T4) levels increased during a shorter period of time in preterm lambs, resulting in a lowered T4 rise; the T3 response was not affected by prematurity. After TRH injection, the rises in plasma T3 and T4 levels were significantly higher in preterm than in full-term lambs, suggesting a pituitary hypersensitivity to TRH linked to prematurity. Moreover it appeared that the response of reverse T3 to TSH or TRH was very weak.
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PMID:Endocrine activity in preterm and full-term lambs. 1. Adrenal response to synacthen. 2. Thyroid response to ovine thyroid-stimulating hormone or thyrotropin-releasing hormone. 392 27

Adrenal steroidogenesis was evaluated in 25 sick premature infants with a gestational age of less than 30 weeks. ACTH stimulation tests were performed on the fourth day of life using synthetic ACTH (36 micrograms/kg). Considering the stress and degree of illness, preterm newborns had low basal cortisol levels (mean +/- SEM, 207.4 +/- 23.5 nmol/L), and their levels were similar to basal levels reported for healthy full-term newborns (170.7 +/- 26.8 nmol/L; P = 0.31; reference data from Endocrine Sciences, Inc., Calabasas Hills, CA). However, compared to term neonates, preterm infants had markedly elevated basal levels of 17-hydroxypregnenolone (54.3 +/- 11.2 nmol/L), 17-hydroxyprogesterone (19.7 +/- 4.0 nmol/L), and 11-deoxycortisol (19.1 +/- 3.3 nmol/L), which were 7-, 18-, and 8-fold higher, respectively, than values for term infants. The activity of 3 beta-hydroxysteroid dehydrogenase was not significantly reduced in extremely premature neonates (mean basal ratio of 17-hydroxypregnenolone/17-hydroxyprogesterone, 2.9 +/- 0.2; ACTH-stimulated ratio, 6.5 +/- 0.4). In contrast, the mean basal substrate/product ratio of 11-deoxycortisol was markedly elevated in the preterm infants (11.9 +/- 2.2, ratio x 10(-2) compared to that in the full-term infants (2.1 +/- 0.4, ratio x 10(-2); P < 0.001). These findings are consistent with decreased activity of 11 beta-hydroxylase (11 beta OH) in preterm infants born at less than 30 weeks gestation. Decreased 11 beta OH activity appears to be more prominent than the deficiency of 3 beta-hydroxysteroid dehydrogenase that has been found in infants with lesser degrees of prematurity, suggesting that 11 beta OH activity may be regulated during fetal development to increase during the latter part of gestation.
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PMID:Adrenal steroidogenesis in very low birth weight preterm infants. 810 10

This review summarises comparative aspects of equine pregnancy and birth. The allantochorion covers the entire endometrial surface of the mare's uterus and the placenta is microcotyledonary and epitheliochorial in structure. The foetus has, therefore, to pass through the allantochorion at birth. The umbilical cord has amniotic and allantoic portions and remains intact after delivery, enabling an arterial venous circulation to be maintained for several minutes. Maternal IgG does not cross the placental barrier and passive transfer post-natally is essential for immune status. Gestation in Thoroughbreds is 340 days with a wide range (320-360 days). Birth may be induced by oxytocin but dose rate is related inversely to gestational age. Normal foals rise, suck from the mare and gallop within 4 h after birth. Categorisation of newborn foal diseases into infective (Group 1) and non-infective (Groups 2, 3 and 4) conditions is presented. The neonatal maladjustment syndrome (NMS) affects full-term individuals, causing cerebral oedema, haemorrhage and/or ischaemic necrosis. NMS is related to the birth process and myocardial 'injury'. Prematurity and dysmaturity have origins in pre-natal disturbances of foetal maturation and physiology. Prematurity is a term ascribed to foals delivered at less than 320 days gestation whereas dysmaturity, for clinical convenience, describes foals born in the full-term period showing premature-like signs. Dysmature foals are generally associated with placental pathology. However, the distinction between the two groups is tenuos. Recent evidence suggests that 1) placental pathology is often present in premature foals; 2) differences exist in the degree of adrenocortical function. These affect clinical signs, prognosis and course of the condition. Placental pathology results in precocious adrenocortical maturation but the effect on maturation of other organ systems requires further study. Premature/dysmature foals fall into two groups; those with a favourable clinical outcome and those which make progress during the first 24 h post partum but deteriorate with development of neurological, metabolic and respiratory deficits (second day syndrome). Two models have been established to study premature/ dysmature foals. The first, developed in the early 1980s, was based on induction of mares from 280 days gestation to full term, using oxytocin. A premature, intermediary (twilight) and full-term status of adrenocortical function were identified; these categories correlating with changes in mammary secretion electrolytes. The same groupings have been related to other organ systems and metabolic functions of maturation. The second model establishes placental pathology from 220 to 260 days of gestation. A small area of placenta is separated from its uterine attachment, using a videoendoscope introduced through the cervix. Precocious adrenocortical function has been induced although further work is required to confirm the model as a means of investigating the pathogenesis of dysmaturity. Foetal injections of ACTH, CRH or betamethasone cause precocious increases in maternal plasma pregnane concentrations.
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PMID:Clinical view of disturbances in equine foetal maturation. 907 28

Glucocorticoids play an important role in prenatal organ maturation in many species. In humans, maternal treatment with synthetic glucocorticoids improves neonatal adaptation of prematurely born infants. In cows, pre-term calf survival is improved following a single maternal glucocorticoid administration. We hypothesized that stimulation of endogenous cortisol secretion by adrenocorticotropin (ACTH) treatment combined with maternal dexamethasone treatment, would be even more efficient in stimulating organ maturation in the prematurely delivered calf. Three groups of premature calves were delivered by caesarian section at 90% of gestation length from dams which were either untreated or injected with dexamethasone before delivery, combined with either prenatal or postnatal ACTH treatment to the calf. During the first 24h after birth, thermoregulation, blood chemistry, liver values and organ weights were recorded. In the untreated calves, survival was significantly correlated with blood oxygenation, sodium and calcium levels at the moment of birth. There were marked maturational effects of the treatments on body temperature regulation, blood acid-base status, oxygenation, glucose, insulin, IGF-1 levels, weight of the heart, liver, gastrointestinal tract and thymus weight. For many of the measured metabolic, endocrine and organ weight parameters, the intrauterine ACTH treatment was associated with improved values relative to the postnatal ACTH treatment, which appeared to have no immediate effect on calf viability. In conclusion, the premature calf delivered by caesarian section at 90% of gestation length showed blood chemistry, metabolic, endocrine and organ growth characteristics that indicated severe prematurity. However, the maturation of organ function in newborn premature calves following maternal glucocorticoid injections was further enhanced if is was preceded by intra-fetal injections of ACTH.
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PMID:Combined ACTH and glucocorticoid treatment improves survival and organ maturation in premature newborn calves. 1501 68

Monitoring of blood glucose is usually reported to reduce the risk of hypoglycemia in term newborns with high risk factors and for prematurity in neonatal intensive care unit patients. Differential diagnosis has rarely been discussed. In the eutrophic term newborn, hypoglycemia remains rare and an etiological diagnosis must be made. Intensive management of neonatal hypoglycemia is required to prevent neurodevelopmental defects. Without evident cause or if hypoglycemia persists, a systematic review of possible causes should be made. We report isolated glucocorticoid deficiency diagnosed in an infant at 10 months of age. This boy had neonatal hypoglycemia and mild jaundice that had not been investigated. During his first 9 months of life, he presented frequent infections. At 10 months of age, febrile seizures occurred associated with shock, hypoglycemia, hyponatremia, mild hyperpigmentation, and coma. He was diagnosed with hypocortisolemia and elevated ACTH levels. Brain injury was revealed by MRI after resuscitation, with hypoxic-ischemic and hypoglycemic encephalopathy. The molecular studies demonstrated the presence of p.Asp107Asn and previously unreported frameshift p.Pro281GlnfsX9 MC2R gene mutations. A substitutive hormone therapy was provided and during a follow-up of 12 months no adrenal crisis was noted. We report an unusual case of familial glucocorticoid deficiency with severe neurological injury. This case demonstrates the importance of an appropriate etiological diagnosis in neonatal hypoglycemia.
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PMID:[Uncommon neonatal case of hypoglycemia: ACTH resistance syndrome]. 2544 27

With fewer than 200 reported cases, Cushing's syndrome (CS) in pregnancy remains a diagnostic and therapeutic challenge. In normal pregnancies, misleading signs may be observed such as striae or hypokalemia, while plasma cortisol and urinary free cortisol may rise up to 2- to 3-fold. While the dexamethasone suppression test is difficult to use, reference values for salivary cortisol appear valid. Apart from gestational hypertension, differential diagnosis includes pheochromocytoma and primary aldosteronism. The predominant cause is adrenal adenoma (sometimes without decreased ACTH), rather than Cushing's disease. There are considerable imaging pitfalls in Cushing's disease. Aberrant receptors may, in rare cases, lead to increased cortisol production during pregnancy in response to HCG, LHRH, glucagon, vasopressin or after a meal. Adrenocortical carcinoma (ACC) is rare and has poor prognosis. Active CS during pregnancy is associated with a high rate of maternal complications: hypertension or preeclampsia, diabetes, fractures; more rarely, cardiac failure, psychiatric disorders, infection and maternal death. Increased fetal morbidity includes prematurity, intrauterine growth retardation and less prevalently stillbirth, spontaneous abortion, intrauterine death and hypoadrenalism. Therapy is also challenging. Milder cases can be managed conservatively by controlling comorbidities. Pituitary or adrenal surgery should ideally be performed during the second trimester and patients should then be treated for adrenal insufficiency. Experience with anticortisolic drugs is limited. Metyrapone was found to allow control of hypercortisolism, with a risk of worsening hypertension. Cabergoline may be an alternative option. The use of other drugs is not advised because of potential teratogenicity and/or lack of information. Non-hormonal (mechanical) contraception is recommended until sustained biological remission is obtained.
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PMID:MANAGEMENT OF ENDOCRINE DISEASE: Management of Cushing's syndrome during pregnancy: solved and unsolved questions. 2952 33

Maternal separation, hypoxia, and hypothermia are common stressors in the premature neonate. Using our rat model of human prematurity, we evaluated sexual dimorphisms in the long-term effects of these neonatal stressors on behavior of the hypothalamic-pituitary-adrenal (HPA) axis in adult rats. Neonatal rats were exposed daily on postnatal days 2 to 6 to maternal separation with normoxia, with hypoxia allowing spontaneous hypothermia, with hypothermia per se, and with hypoxia while maintaining isothermia with external heat. The major findings were that (a) prior maternal-neonatal separation during the first week of postnatal life attenuated the plasma ACTH and corticosterone response to restraint stress in adult male but not female rats, (b) prior neonatal hypothermia augmented the plasma ACTH and corticosterone response to restraint stress in adult male rats, but not female rats, and (c) changes in hypothalamic, pituitary, and adrenal mRNA expression did not account for most of these HPA axis effects. Most of the programming effects on adult HPA axis was attributed to prior maternal-neonatal separation alone (with normoxia) because the addition of hypoxia with spontaneous hypothermia, hypothermia per se, and hypoxia while preventing hypothermia during maternal-neonatal separation had minimal effects on the HPA axis. These results may inform strategies to prevent sexually dimorphic sequelae of neonatal stress including those due to medical interventions.
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PMID:Programming of the Adult HPA Axis After Neonatal Separation and Environmental Stress in Male and Female Rats. 2987 93