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8/12/2019 3 Prof. Sofie LATEST-fetus as a Patient, Lung Maturation. Ro
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PREPARINGFetal Lung Maturation
Role of Vitamins and Minerals
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INTRODUCTION
Survival of preterm fetus depends on thematurational stage of the lung.
The pulmonary system is among the lastof fetal organ system to mature, bothfunctionally and structurally
5 stages of lung development
The viability of the human fetus increasesafter 25 weeks’ gestation (saccular stage)
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Morphogenesis
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ostnatal development
The proliferation of alveoli, accompanying vessels, continous after
birth until the adult number of alveoli is reached (by 2-3 years of
age).
Stabilization of the morphological pattern of the lungs does not
occur until about 8 years of age.
Alveolar size and surface area continue to increase beyondadolescence.
Hislop AA,J Anat 2002;201:325 Haworth SG, Hislop AA. Semin in Neonatol 2003:8:1
Hislop AA. Paediatr Resp Rew 2005;6:35
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The action of corticosteroidintervention to Fetal Lung
Increase protein production
Increase in surfactant synthesis
Increase in surfactant secretion
Induction of pulmonary ß-adrenergic receptors
Stimulation of production of fibroblast —
pneumonocyte factor
Increase in plasma levels of triiodothyronine
Conversion of thyroxine to triiodothyronine
Induction of conversion of noradrenaline to
Adrenaline
Stimulation of glycogenolysis
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Corticosteroid intervention
Only prevent RDS in + 40-50% of pretermcases
Increased fetal and maternal RBP
(invitro/invivo (steroidal efficacy or retinoidutilization?)
No evidence glucocorticosteroid interventionare effective in promoting lung maturation
before 24 weeks (before alveolirization) The Glucocorticoids did not promote further
structural development
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Other methods to acceleratefetal lung maturation
Thyroid hormones
Bromhexine metabolite VIII
Carnitine Thyrotropin Stimulating Hormone
Schellenberg JC, Liggins GC. New approaches to hormonal acceleration of fetal lungmaturation. J.Perinat.Med.15(1987);447-52
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Vitamins and Mineral inPregnancy
Have an essential roles in cellularmetabolism, maintenance and growththroughout life.
Folic acid, the minerals zinc, iron andcopper and the antioxidant vitaminsA, D and E are of particular
importance during pregnancy. They are also central components of
many enzymes and transcription
factors.
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Animal studiesNutrition is important to normal lung
development and maturation
Malnutrition can delay somatic growth
and the development of new alveoli. Early malnutrition has been shown to
alter surfactant lipid compositionCurle DC, Adamson IYR: Retarded development of neonatal rat lung by maternal
malnutrition. J.Histochem Cytochem 1978; 26:401-8
Masuyama H, Hiramatsu Y, Kudo T. Effect of retinoids on fetal lung development in therat. Biol Neonate 1995; 67:264-273
DeSanti A, McDowell E, Strum J. Airway branching patterns and cytodifferentiation incultured fetal hamster lung. Tissue Cell 1992; 24: 853-68.)
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Effects of a 50% reduction in maternalplasma retinol concentrations on late fetaldevelopment in rats.
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Vitamin A and the Lung
The Lungs are sensitives to maternal vitamin A deficiency.
Result immature lungs
= reduced bronchial branching
= reduced elastin (important for alveolar maturation) Influences lung capacity in the neonates
Administration all trans-Retinoic Acid:
Promotes septation and increases number of alveoli
Increase expression of mRNA cellular RBP
Increase plasma level VEGF and lung alveolardevelopment
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Conceptual framework for how maternal micron utr ient status m ay affect the organ funct ion
Chris tian P , and Stewart C P J. Nutr. 2010;140:437-445
©2010 by American Society for Nutrition
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VITAMIN A / RETINOIC ACID
• Essential for lung maturation
Stimulating effect on lung growth and maturation
- initial growth
- maturation lung epithelium
- accelerate fetal lung branching
- alveogenesis- favor cholin incorporation into phosphatidylcholine
Surfactant
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VITAMIN D
Plays a role in lung development due tovitamin D’s interaction with vitamin A.
During the third trimester the need for vitamin
D of pregnancy increased. Vitamin D Deficiency Alters Lung Growth and
Decreases Lung Function
Graeme R. Zosky,Luke J. Berry, John G. Elliot, Alan L.James, Shelley Gorman, and Prue H. HartAmerican Journal of Respiratory and Critical CareMedicine, Vol. 183, No. 10 (2011), pp. 1336-1343.
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VITAMIN E
Increase transcription of surfactantsproteins acting directly to type IIcells.
Improves Lung Growth in Fetal Rats
Yoshimura S, Masuzaki H, Nakayama D, Kitajima M, Yoshida
A, Ishimaru T. Acta Med Nagasaki 47: 117-121. 2002
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MINERALS
Zn is a central part of > 300 enzymesand proteins
Fe, Zn, Ca (Hormonal adaptations)
Chr ist ian P , and Stewart C P J . Nutr. 2010;140:437-445
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CONCLUSION
Some Vitamins ( A , D and E, folate,B12) and Minerals (Zn, Fe, Ca) areessensial for growth and maturationof the Lung
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Thank you
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