Plasma Aldosterone Concentration at Delivery and during the Newborn Period

Beitins, Inese Z.; Bayard, Françis; Levitsky, Lynne L.; Ances, Isadore G.; Kowarski, Avinoam; Migeon, Claude J.

doi:10.1172/jci106824

Cited by 101 publications

(33 citation statements)

References 59 publications

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“…These results are in accordance with previous studies that have reported high levels of aldosterone in neonates (10) compared with their mothers (21). Although aldosterone has been previously shown to cross the placental barrier from the mother to the fetus (20), highest aldosterone levels detected in the cord blood are consistent with de novo synthesis in the fetal adrenal gland, given the very early expression of the aldosterone synthase gene starting from 13 gestational weeks (22).…”

Section: Discussionsupporting

confidence: 92%

Physiological Partial Aldosterone Resistance in Human Newborns

Martinerie

Pussard

L’Hélias³

et al. 2009

Pediatr Res

101

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ABSTRACT:In the neonatal period, the human kidney is characterized by an impaired ability to regulate water and sodium homeostasis, resembling partial aldosterone resistance. The aim of our study was to assess this hormonal insensitivity in newborn infants and to determine its relationship with neonatal sodium handling. We conducted a prospective study in 48 healthy newborns and their mothers. Aldosterone, renin, and electrolyte concentrations were measured in umbilical cords and in maternal plasma. Urinary aldosterone concentrations and sodium excretion were determined at urination within 24 h after birth. A significant difference was observed between aldosterone and renin levels in newborn infants compared with their mothers (817 Ϯ 73 versus 575 Ϯ 55 pg/mL and 79 Ϯ 10 versus 15 Ϯ 2 pg/mL, respectively, p Ͻ 0.001). This hyperactivation of the renin-angiotensin-aldosterone system was associated with hyponatremia and hyperkalemia in the newborn infants, and high urinary sodium loss, consistent with a partial aldosterone resistance at birth. Unlike plasma aldosterone, urinary aldosterone concentration was found highly correlated with plasma potassium concentrations, thus representing the best index for accurate evaluation of mineralocorticoid sensitivity. Our study represents a comprehensive characterization of the renin-aldosterone axis in newborn infants and provides evidence for physiologic partial aldosterone resistance in the neonatal period. (Pediatr Res 66: 323-328, 2009) T he human kidney displays a tubular immaturity at birth, with sodium waste, responsible for a negative sodium balance, and an impaired ability to reabsorb water (1), which is aggravated under circumstances such as prematurity, pyelonephritis, and gastroenteritis (2). This inability to maintain homeostatic functions is a major problem encountered by pediatricians, most notably in preterm infants. Indeed, the challenge is to find a balance between the lethal risk of dehydration and the associated morbidity of excessive hydromineral supplementation, contributing to severe complications such as intraventricular hemorrhage and bronchopulmonary dysplasia (3). A better understanding of water and sodium regulation in the neonatal period is a prerequisite to propose new therapeutic strategies for the management of preterm infants.Sodium reabsorption is mainly controlled by aldosterone, a steroid hormone synthesized in the zona glomerulosa of the adrenal gland, secondary to renin stimulation via angiotensin II and to potassium stimulation (4). In the distal nephron, aldosterone, by binding to its receptor, the mineralocorticoid receptor, a transcription factor (5), tightly regulates the expression and the activity of several transport proteins implicated in sodium, potassium, and water homeostasis, as the alpha subunit of the epithelial sodium channel (6), the Na-KATPase (7), and the aquaporin 2 (8). A possible role of a partial and transient tubular unresponsiveness to this hormone has been suggested to account for sodium waste in neonates (9,10)....

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Section: Discussionsupporting

confidence: 92%

Physiological Partial Aldosterone Resistance in Human Newborns

Martinerie

Pussard

L’Hélias³

et al. 2009

Pediatr Res

101

View full text Add to dashboard Cite

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“…Newborn animals and humans have higher aldosterone concentrations than adults. 19,20 Preterm infants with a mean gestational age of 31 weeks who did not receive sodium supplementation showed an increase in plasma aldosterone concentration and urinary aldosterone excretion over the first few weeks of life, followed by a decrease over the following 2 weeks. Conversely, no changes in these measurements were observed in infants who received supplemental sodium when compared with full-term newborn infants.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Function and Electrolyte Balance Following Spironolactone Treatment in Preterm Infants With Chronic Lung Disease: A Double-Blind, Placebo-Controlled, Randomized Trial

2000

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OBJECTIVE:To study the effect of spironolactone on dietary electrolyte supplementation, pulmonary function, and electrolyte balance in premature infants with chronic lung disease. STUDY DESIGNA double-blind, randomized, and placebo-controlled trial was designed to study two groups of low birth weight infants with chronic lung disease at Pennsylvania Hospital. The placebo group received chlorothiazide and a placebo, and the spironolactone group received chlorothiazide and spironolactone during the 2-week study period. A two-tailed t-test was used to determine equivalence between the two groups. RESULTSPulmonary compliance, resistance and tidal volume, serum sodium and potassium, and FIO 2 , were not statistically different between the two groups. The need for sodium and/or potassium chloride did not differ between the two groups, nor did the quantity of each salt. CONCLUSIONThe addition of spironolactone did not reduce the requirement for supplemental electrolytes, nor did it improve pulmonary mechanics or electrolyte balance. Journal of Perinatology 2000; 1:41-45.Chronic lung disease may develop in premature infants who require mechanical ventilation and prolonged high concentrations of inspired oxygen for the management of respiratory distress syndrome. This disease affects from 5% to 20% of premature newborn infants who receive intermittent positive pressure ventilation. 1 Long-term diuretic therapy is an important component of the care received by premature infants with chronic lung disease.2 The combination of oral chlorothiazide and spironolactone has been shown to decrease mean airway resistance and increase airway conductance and compliance in premature infants diagnosed with bronchopulmonary dysplasia.3 The use of Aldactazide (a 1:1 mixture of spironolactone and hydrochlorothiazide), however, did not improve pulmonary mechanics or oxygenation despite the occurrence of a diuresis.4 Further, potassium depletion is a known complication of diuretic administration. A common medical practice among neonatologists is to add spironolactone to the diuretic regimen to decrease the degree of hypokalemia and hyperkaliuria.5 Despite the addition of this potassiumsparing diuretic, many neonates still require dietary supplementation with potassium chloride and/or sodium chloride. However, the additive effect of spironolactone to thiazide therapy on pulmonary mechanics and electrolyte balance has not been studied. Because the distal convoluted tubule in the premature infant is less responsive to the effects of aldosterone than in older children, 6 the administration of spironolactone, the synthetic antagonist of aldosterone, may not have an important role in the maintenance of potassium balance or in the improvement of pulmonary mechanics in low birth weight infants with chronic lung disease.This double-blind, placebo controlled randomized study was performed to determine whether the addition of spironolactone to a chlorothiazide regimen would decrease the need for electrolyte supplementation. The secondary aim was to de...

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“…Accompanying these findings, histochemical changes such as an increased activity of glucose-6-phosphate dehydrogenase means that the glomerular cells of the fetus can react functionally to specific stimulus (7). The condition of sodium restriction of the mother alters the aldosterone secreting rate of the human fetus (1,2,6). Although the degree of sodium restriction given to the mother in this experiment is standard in the rat, the sodium restriction experiment in the rat must be repeated not only morphologically but also quantitatively, changing the degree of sodium restriction.…”

Section: Discussionmentioning

confidence: 99%

“…Aldosterone has already been detected in the fetuses of human, chicken, mice and guinea pigs (1,2,3,4,6,8), and the zona glomerulosa of the fetus is thought to be functional in the late stage of gestation (1,2,5,14). According to our previous study, (12,13,14), the zona glomerulosa of fetal rats is almost well differentiated in the latest stage of gestation.…”

mentioning

confidence: 82%