Pulmonary Hypoplasia Induced by Oligohydramnios: Findings from Animal Models and a Population-Based Study

Wu, Chun Shan; Chen, Chung-Ming; Chou, Hsin Hua

doi:10.1016/j.pedneo.2016.04.001

Cited by 37 publications

(22 citation statements)

References 47 publications

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“…Lung development is distinct from other organs as the lung is filled by fluid in utero, but following birth, it has to rapidly adapt to facilitate breathing . Consequently, the structure is not fully developed and remodelling continues during postnatal saccular and alveolar stages (Figure ) .…”

Section: Signalling Pathwaysmentioning

confidence: 99%

Lung development and emerging roles for type 2 immunity

Loering

Cameron

Starkey

et al. 2019

The Journal of Pathology

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Lung development is a complex process mediated through the interaction of multiple cell types, factors and mediators. In mice, it starts as early as embryonic day 9 and continues into early adulthood. The process can be separated into five different developmental stages: embryonic, pseudoglandular, canalicular, saccular, and alveolar. Whilst lung bud formation and branching morphogenesis have been studied extensively, the mechanisms of alveolarisation are incompletely understood. Aberrant lung development can lead to deleterious consequences for respiratory health such as bronchopulmonary dysplasia (BPD), a disease primarily affecting preterm neonates, which is characterised by increased pulmonary inflammation and disturbed alveolarisation. While the deleterious effects of type 1-mediated inflammatory responses on lung development have been well established, the role of type 2 responses in postnatal lung development remains poorly understood. Recent studies indicate that type 2-associated immune cells, such as group 2 innate lymphoid cells and alveolar macrophages, are increased in number during postnatal alveolarisation. Here, we present the current state of understanding of the postnatal stages of lung development and the key cell types and mediators known to be involved. We also provide an overview of how stem cells are involved in lung development and regeneration, and the negative influences of respiratory infections.No conflicts of interest were declared. Recently, it has been shown that in mice, mechanical forces are involved in organ development by controlling the ratio of fixed and rotating spindles needed for normal

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Section: Signalling Pathwaysmentioning

confidence: 99%

Lung development and emerging roles for type 2 immunity

Loering

Cameron

Starkey

et al. 2019

The Journal of Pathology

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“…It is well established that fetal lung development is dependent on the presence of an adequate volume of amniotic fluid and that fetal exposure to severe oligohydramnios during critical periods of gestation may result in pulmonary hypoplasia. Although pulmonary hypoplasia has been associated mainly with severe oligohydramnios in early gestation (< 20–22 weeks), there are insufficient data on whether this association extends to severe oligohydramnios during the late‐second or early‐third trimester, as well as regarding the degree of oligohydramnios that carries respiratory consequences.…”

Section: Introductionmentioning

confidence: 99%

Amniotic fluid volume at presentation with early preterm prelabor rupture of membranes and association with severe neonatal respiratory morbidity

Weiner

Barrett

Zaltz

et al. 2019

Ultrasound in Obstet & Gyne

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Objective Amniotic fluid volume (AFV) plays an important role in early fetal lung development, and oligohydramnios in early pregnancy is associated with pulmonary hypoplasia. The aim of this study was to evaluate the association between AFV at the time of presentation with early preterm prelabor rupture of membranes (PPROM) and severe neonatal respiratory morbidity and other adverse pregnancy outcomes. Methods This was a retrospective study of all women with a singleton pregnancy, admitted to a single tertiary referral center between 2004 and 2014, for expectant management of PPROM at 20 + 0 to 28 + 6 weeks' gestation. The primary exposure was AFV at presentation, classified according to sonographic maximum vertical pocket (MVP) as: normal AFV (> 2 cm), oligohydramnios (≤ 2 cm and > 1 cm) or severe oligohydramnios (≤ 1 cm). The primary outcome was a composite variable of severe respiratory morbidity, defined as either of the following: (1) need for respiratory support in the form of mechanical ventilation using an endotracheal tube for ≥ 72 h and need for surfactant; or (2) bronchopulmonary dysplasia, defined as requirement for oxygen at postmenstrual age of 36 weeks or at the time of transfer to a Level‐II facility. Adjusted odds ratios (aOR) and 95% CI for the primary and secondary outcomes were calculated for each AFV‐at‐presentation group (using normal AFV as the reference), adjusting for gestational age (GA) at PPROM, latency period, birth weight, mode of delivery and chorioamnionitis. Results In total, 580 women were included, of whom 304 (52.4%) had normal AFV, 161 (27.8%) had oligohydramnios and 115 (19.8%) had severe oligohydramnios at presentation. The rates of severe respiratory morbidity were 16.1%, 26.7% and 45.2%, respectively. Compared with normal AFV at presentation, oligohydramnios (aOR, 3.27; 95% CI, 1.84–5.84) and severe oligohydramnios (aOR, 4.11; 95% CI, 2.26–7.56) at presentation were associated independently with severe respiratory morbidity. Other variables that were associated independently with the primary outcome were GA at PPROM (aOR, 0.54; 95% CI, 0.43–0.69), latency period (aOR, 0.94; 95% CI, 0.91–0.98) and Cesarean delivery (aOR, 2.01; 95% CI, 1.21–3.32). Conclusions In women with early PPROM, AFV at presentation, as assessed by the MVP on ultrasound examination, is associated independently with severe neonatal respiratory morbidity. This information may be taken into consideration when counseling women with early PPROM regarding neonatal outcome and management options. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…11 In fact, the effects of scant space and mechanical pressure in utero caused by decreased amniotic fluid on limb or lung development are discussed widely in both animal models and humans. 19,[26][27][28][29] We suggest that an abnormal uterine environment in which the fetus grows exposed to decreased volume of amniotic fluid and limited space may also cause subsequent neurodevelopmental abnormalities. 30 This insufficient space may affect neurodevelopment in utero, directly or indirectly, and manifest only later in childhood.…”

Section: Discussionmentioning

confidence: 93%

Isolated oligohydramnios and long-term neurological morbidity of the offspring

Dorot

Wainstock

Walfisch

et al. 2019

J Dev Orig Health Dis

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This study aimed to assess the association between maternal-isolated oligohydramnios (IO) and offspring long-term neurological complications. A population-based retrospective cohort study was conducted, including all births at a single tertiary medical center in Israel between the years 1991 and 2014. Multiple pregnancies and potential pregnancy complications associated with oligohydramnios were excluded. The computerized obstetrical database was linked with the computerized dataset of all pediatric hospitalizations of the same medical center. Evaluation of cumulative neurological-associated hospitalizations rate over time was compared using a Kaplan–Meier survival curve. The Weibull survival parametric model was conducted to assess the neurological-associated hospitalization risk in the presence of IO, while accounting for potential confounders. A total of 190,259 pregnancies were included in the study, of which 4063 (2.13%) pregnancies were complicated with IO. Total neurological-related hospitalizations were significantly more common in the IO group (3.7% in the IO group and 3.0% in the comparison group, p = 0.005). Pervasive developmental disorder, movement disorders, developmental disorders, and degenerative and demyelization disorders were all specific neurological diagnoses significantly more common in the exposed group. The survival curve demonstrated a significantly higher cumulative hospitalization rate in the exposed group (log-rank p = 0.001). Using a multivariate model adjusting for gestational age, maternal age, and labor induction, an independent association between IO and long-term neurological morbidity of the offspring was observed (adjusted hazard ratio 1.203; 95% CI 1.02–1.42). In summary, a significant association was found between pregnancies complicated by IO and long-term neurological morbidity of the offspring.

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Pulmonary Hypoplasia Induced by Oligohydramnios: Findings from Animal Models and a Population-Based Study

Cited by 37 publications

References 47 publications

Lung development and emerging roles for type 2 immunity

Lung development and emerging roles for type 2 immunity

Amniotic fluid volume at presentation with early preterm prelabor rupture of membranes and association with severe neonatal respiratory morbidity

Isolated oligohydramnios and long-term neurological morbidity of the offspring

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