NEW STRATEGIES TO MATURE THE PREMATURE FETUS

此PERC应用程序旨在开发和测试新的 早产时实现胎儿成熟的策略 迫在眉睫 其目标是通过以下方式改善早产儿的结局： 最大限度地减少与器官功能相关的产后并发症 不成熟 重点是整体胎儿成熟，而不是 更传统的关注仅是肺成熟。 的研究项目 只专注于测试可以使用的激素治疗策略 临床上 早产胎羊将由核心单位处理， 激素和激素的组合，然后递送用于研究 出生后的适应和器官功能。 胎儿治疗将由 通过超声引导注射直接给药胎儿， 评估成熟对无应激胎儿的影响。 剂量 时间表将强调单剂量的药剂和 药物如皮质类固醇、T3、TRH和EGF。 影响将 在出生后5小时内通过器官特异性研究项目进行评价 通过评估肺功能、肾功能、血管 音调调节和神经内分泌适应性反应。 然后将组织 被研究项目用来衡量成熟的影响， 肺、肾、血管和神经内分泌系统。 在最初的3 年，临床研究将评估肾脏，神经内分泌和 母体用倍他米松治疗引起的血管效应 或倍他米松加TRH与未治疗的对照组相比。 母亲治疗方案正在Harbor-UCLA和King-Drew进行 医学中心，并将为重点临床提供受试者 建议对PERC进行评估。 临床试验将在 在提案的最后几年， 在早产的羔羊。

This PERC application is directed toward developing and testing new strategies for achieving fetal maturation when preterm delivery is imminent. The goal is to improve outcome for preterm infants by minimizing postnatal complications related to organ functional immaturity. The emphasis is on global fetal maturation rather than the more traditional focus on lung maturation only. The research projects focus on testing only hormone treatment strategies that could be used clinically. Preterm fetal sheep will be treated by the Core Unit with hormones and combinations of hormones followed by delivery for the study of postnatal adaptation and organ function. Fetal treatments will be by direct fetal administration by ultrasound guided injections to permit us to assess maturational effects on unstressed fetuses. The dosage schedules will emphasize single doses of agents and combinations of agents such as corticosteroid, T3, TRH, and EGF. Effects will be evaluated by organ specific Research Projects during a 5 hr postnatal study period by evaluating lung performance, kidney function, vascular tone regulation and neuroendocrine adaptive responses. tissue will then be used by the Research Projects to measure maturational effects in the lungs, kidneys, vascular and neuroendocrine systems. In the initial 3 years, the clinical studies will evaluate kidney, neuroendocrine and vascular effects resulting from maternal treatments with betamethasone or betamethasone plus TRH in comparison to an untreated comparison group. The maternal treatment protocol is ongoing at Harbor-UCLA and King-Drew Medical Center and will provide subjects for the focused clinical evaluations proposed for the PERC. A clinical trial will be designed in the final years of the proposal that incorporate the concepts developed in the preterm lambs.