Abstract
Background
Antenatal glucocorticoids (GCs) reduce respiratory distress syndrome (RDS) in preterm infants and are associated with reduced lung liquid content. Our aim was to assess whether airway gene expression of mediators of pulmonary epithelial sodium and liquid absorption, and further, respiratory morbidity, associate with cord blood GC concentrations.
Methods
The study included 64 infants delivered <32 weeks gestation. Cortisol and betamethasone in umbilical cord blood were quantified with liquid chromatography-tandem mass spectrometry. The total GC concentration was calculated. Gene expression of the epithelial sodium channel (ENaC), Na,K-ATPase, and serum- and GC-inducible kinase 1 at <2 h and at 1 day postnatally in nasal epithelial cell samples was quantified with reverse transcription-polymerase chain reaction. The mean oxygen supplementation during the first 72 h was calculated.
Results
Concentrations of cord blood betamethasone and total GC were significantly lower in infants with RDS and correlated with mean oxygen supplementation. Expression of αENaC and α1- and β1Na,K-ATPase at <2 h correlated with betamethasone and total GC concentrations. Expression of Na,K-ATPase was lower in infants with RDS.
Conclusion
Enhancement of lung liquid absorption via increased expression of sodium transporters may contribute to the beneficial pulmonary effects of antenatal GCs.
Impact
-
RDS is related to lower umbilical cord blood GC concentrations and lower airway expression of sodium transporters.
-
In addition to the timing of antenatal GC treatment, resulting concentrations may be of importance in preventing RDS.
-
Induction of sodium transport may be a factor contributing to the pulmonary response to antenatal GCs.
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Acknowledgements
We thank the personnel at the maternal and delivery wards of the Women’s Hospital and the NICU nurses at the Children’s Hospital, Helsinki University Hospital for their kind assistance during recruitment and sample collection. Ms. Marita Suni and Ms. Sari Lindén are thanked for help with data acquisition and laboratory analysis. We also are grateful for the contributions of Associate Professor Petteri Hovi and statistician Mitja Lääperi for statistical analyses. This work was funded by Finska Läkaresällskapet, Foundation for Pediatric Research in Finland, the Finnish Special Governmental Subsidy for Health Sciences.
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L.S. and A.C.J. conceptualized and designed the study, collected data, carried out the initial analyses, drafted the initial manuscript, and completed its final submitted version. P.A.P. and S.A. conceptualized and designed the study, collected data, interpreted data, and critically revised the manuscript. O.M.H. and M.A.K. conceptualized and designed the study, interpreted data, and critically revised the manuscript. M.J.L. managed data collection instruments, collected data, and critically revised the manuscript. L.U.T. designed instruments for data analyses, carried out data analyses, drafted part of the initial manuscript and critically revised the manuscript. All authors approved the final manuscript as submitted.
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Süvari, L., Helve, O.M., Kari, M.A. et al. Glucocorticoids, sodium transport mediators, and respiratory distress syndrome in preterm infants. Pediatr Res 89, 1253–1260 (2021). https://doi.org/10.1038/s41390-020-1061-9
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DOI: https://doi.org/10.1038/s41390-020-1061-9
