Minimizing respiratory injury in preterm births.

• Position: Pulmonary Health

Physicians have a better understanding of how antenatal cortico-steroids should be used in the treatment of prematurity, thanks to research by Alan Jobe, Division of Pulmonary Biology, Cincinnati (Ohio) Children's Research Foundation.

Subclinical chorioamnionitis (a prenatal infection commonly found in mothers whose placentas rupture) is frequently associated with preterm deliveries before 30 weeks' gestation. Current guidelines advise maternal glucocorticoid treatment to help the preterm lungs to mature. Fetal exposure to proinflammation can cause acute and chronic injury, but, paradoxically, the inflammation can stimulate fetal lung maturation. Both glucocorticoid given after birth and inflammation affect respiratory development in the same way--by inducing the surfactant system and structural maturation, and inhibiting the development of the lung's alveoli.

Jobe and his colleagues are focusing on lung maturation and function, learning how pulmonary development goes awry, and how to minimize injury. They are modeling lung inflammation and maturation in fetal animals which, when delivered preterm...