Preterm birth and sustained inflammation: consequences for the neonate
- PDF / 1,371,072 Bytes
- 18 Pages / 595.276 x 790.866 pts Page_size
- 64 Downloads / 214 Views
REVIEW
Preterm birth and sustained inflammation: consequences for the neonate Alexander Humberg 1,2 & Ingmar Fortmann 1 & Bastian Siller 1 & Matthias Volkmar Kopp 1,3 & Egbert Herting 1 & Wolfgang Göpel 1 & Christoph Härtel 1,4 & German Neonatal Network, German Center for Lung Research and Priming Immunity at the beginning of life (PRIMAL) Consortium Received: 22 May 2020 / Accepted: 24 June 2020 # The Author(s) 2020
Abstract Almost half of all preterm births are caused or triggered by an inflammatory process at the feto-maternal interface resulting in preterm labor or rupture of membranes with or without chorioamnionitis (“first inflammatory hit”). Preterm babies have highly vulnerable body surfaces and immature organ systems. They are postnatally confronted with a drastically altered antigen exposure including hospital-specific microbes, artificial devices, drugs, nutritional antigens, and hypoxia or hyperoxia (“second inflammatory hit”). This is of particular importance to extremely preterm infants born before 28 weeks, as they have not experienced important “third-trimester” adaptation processes to tolerate maternal and self-antigens. Instead of a balanced adaptation to extrauterine life, the delicate co-regulation between immune defense mechanisms and immunosuppression (tolerance) to allow microbiome establishment is therefore often disturbed. Hence, preterm infants are predisposed to sepsis but also to several injurious conditions that can contribute to the onset or perpetuation of sustained inflammation (SI). This is a continuing challenge to clinicians involved in the care of preterm infants, as SI is regarded as a crucial mediator for mortality and the development of morbidities in preterm infants. This review will outline the (i) role of inflammation for short-term consequences of preterm birth and (ii) the effect of SI on organ development and long-term outcome. Keywords Preterm infants . Sustained inflammation . Sepsis . Microbiome . Neurocognitive outcome . Chronic pulmonary insufficiency of prematurity
Determinants of outcome after preterm birth The main driver for the success of modern neonatology was the overarching aim to reduce preterm infant mortality rates. In the last decades, this goal has been achieved in many highincome countries mainly due to the significant progress in the This article is a contribution to the special issue on Preterm birth: Pathogenesis and clinical consequences revisited - Guest Editors: Anke Diemert and Petra Arck * Christoph Härtel [email protected] 1
Department of Pediatrics, University of Lübeck, Lübeck, Germany
2
Ingmar Fortmann and Christoph Härtel (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany
3
Department of Pediatrics, University of Bern, Bern, Switzerland
4
Department of Pediatrics, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany
perinatal management of high-risk pregnancies and the recent advances in neonatal intensive care. Current international network data indicate that preterm babies even at the mar
Data Loading...
