Review on the respiratory adaptation capacity of premature newborn

R. Stănculescu, I. Târcomnicu, C. Coroleucă, G. Sărdescu, C. Coman

Rezumat: Respiratory adaptation of newborn (RANB) is the result of a succession of processes of differentiation and cell growth in lung alveoli and consequently the surfactant system development. The present paper proposes detailed analysis of the literature data on premature newborn respiratory adaptability (PNRA) life outside the womb. Review of the literature on premature newborn respiratory adaptability (ARNNP). Type II alveolar cells of the newborn at small gestational age, 22-24 weeks, synthesize quantitatively 50% of the existing surfactant at birth, this surfactant being fragile and instable. There are significant differences between the amounts of alveolar surfactant at term (100 mg/kg) in relation to the premature newborn (4-5 mg/kg). The abnormal quantity and quality of the surfactant is influenced by the internal and external factors, maternal or fetal. Diseases such as fetal hemorrhage, pulmonary edema and pneumonia cause the appearance of surfactant inactivating protein. Among the factors that inactivate the surfactant in vivo and in vitro are found albumin, fibrinogen, meconium, hemoglobin. Hyperglycemia and hyperinsulinemia inhibit its synthesis. Glucocorticoid hormones, prolactin, estrogen, thyroid hormones, catecholamnines stimulate the synthesis of surfactant in utero. Female premature newborns have surfactant that ensures quantitative and qualitative better adaptability. Endotracheal administration in the first 2 hours of birth of porcine, bovine or synthetic surfactant preparations associated with antenatal corticosteroid administration favors PNRA. PNRA varies with the degree of prematurity but is influenced by other factors such as the sex of the PNB, pregnancy-associated pathology, duration and characteristics of labor, birth modality and the associated pathology of the PNB. These circumstances explain the different capacity of respiratory adaptation of the PNB and influence greatly the response to the administered therapy.
Cuvinte cheie: respiratory adaptation capacity of premature newborn, surfactant.