The replacement of oestradiol and progesterone in very premature infants
The replacement of oestradiol and progesterone in very premature infants
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DOI：
10.3109/07853890009002031
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发表时间：
2000-12-01
影响因子：
4.4
通讯作者：
Pohlandt, F
中科院分区：
文献类型：
--
作者：
Trotter, A;Pohlandt, F
在早产儿中替代17 β-雌二醇（E2）和孕酮（P）的想法是基于以下观察结果：在妊娠期间，母亲和胎儿的E2和P血浆浓度升高100倍。这些激素的胎盘供应中断是足月分娩婴儿的生理事件。早产儿在早期发育阶段就被剥夺了这种供应。在体外和体内的数据进行了讨论，他们强调了E2和P对不同器官系统的发展的潜在好处。出生后补充E2和P的目的是维持子宫内血浆浓度。在30例极早产儿的第一项随机临床研究中，出生后E2和P被替换共6周。E2（4.2-22.9）和P（35.7-87.0）的中位静脉替代剂量为8.4 μ mol/kg/d和67.4 μ mol/kg/d，E2和P的血浆水平分别维持在7.3-22.0 nmol/L和0.95-1.9 μ mol/L的宫内参考值范围内。通过经皮途径需要三到六倍的高剂量。有改善出生后骨矿物质增加和降低慢性肺疾病发病率的趋势，需要进一步研究来阐明E2和P对极早产儿出生后发育的潜在重要作用。
The idea of replacing 17 beta -oestradiol (E2) and progesterone (P) in preterm infants is based on the observation that during pregnancy E2 and P plasma concentrations rise in the mother and the fetus by a factor of 100. Disruption of the placental supply of these hormones is a physiological event for an infant delivered at term. A preterm infant is deprived from this supply at an earlier developmental stage. In vitro and in vivo data are discussed, and they highlights the potential benefit of E2 and P on the development of different organ systems. The postnatal replacement of E2 and P has the aim of maintaining in utero plasma concentrations. In the first randomized clinical study in 30 extremely preterm infants, E2 and P were replaced postnatally for a total of 6 weeks. With a median intravenous replacement of 8.4 mu mol/kg/day of E2 (4.2-22.9) and 67.4 mu mol/kg/day of P (35.7-87.0), plasma levels of E2 and P were maintained within the intrauterine reference values of 7.3-22.0 nmol/L and 0.95-1.9 mu mol/L, respectively. Three- to sixfold higher dosages were needed via the transepidermal route. Trends towards an improved postnatal bone mineral accretion and a reduced incidence of chronic lung disease were found. Further studies are warranted to clarify the potentially important role of E2 and P for the postnatal development of an extremely preterm infant.