Previous work has shown that intrapulmonary delivery of oncotic agents enhance overall lung growth after late gestational fetal tracheal occlusion (TO). This study was a post hoc analysis aimed at determining whether actual alveolar and capillary hyperplasias are maximized in this setting.
Twenty-one near term fetal lambs were evenly divided into 4 groups: group I comprised sham-operated controls; group II had TO alone; and groups III and IV underwent TO and intratracheal infusion of equal amounts of either saline or 25% albumin, respectively. Approximately 2 weeks thereafter, their lungs were examined by detailed alveolar and capillary morphometry before birth. Statistical analysis included analysis of variance and the Bonferroni correction for multiple comparisons (P < .05).
Total alveolar and capillary numbers, as well as total alveolar surface area, were significantly higher in group IV and lower in group I compared with all other groups, with no differences between groups II and III. Alveolar capillary load was normal in all groups.
Intrapulmonary delivery of concentrated albumin safely enhances short-term alveolar and capillary hyperplasia in a late gestational model of fetal TO. This therapeutic concept may allow for TO to be effective and predictable when performed late in gestation.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Pediatric Surgery
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- A randomized trial of fetal endoscopic tracheal occlusion for severe fetal congenital diaphragmatic hernia.N Engl J Med. 2003; 349: 1916-1924
- Fetoscopic tracheal occlusion (FETO) for severe congenital diaphragmatic hernia: evolution of a technique and preliminary results.Ultrasound Obstet Gynecol. 2004; 24: 121-126
- Ion fluxes across the pulmonary epithelium and the secretion of lung liquid in the foetal lamb.J Physiol. 1974; 241: 327-357
- Ontogeny of tracheal fluid, pulmonary surfactant, and plasma corticoids in the fetal lamb.J Appl Physiol. 1975; 39: 1017-1021
- Correction of congenital diaphragmatic hernia in utero VIII: response of the hypoplastic lung to tracheal occlusion.J Pediatr Surg. 1996; 31: 1339-1348
- Fetal hydrops after in utero tracheal occlusion.J Pediatr Surg. 1997; 32 ([discussion 216]): 214-215
- Treatment of severe congenital diaphragmatic hernia by fetal tracheal occlusion: clinical experience with fifteen cases.Am J Obstet Gynecol. 2000; 183: 1059-1066
- Lung pathology in patients with congenital diaphragmatic hernia treated with fetal surgical intervention, including tracheal occlusion.Pediatr Dev Pathol. 2003; 6: 536-546
- Positive intrapulmonary oncotic pressure enhances short-term lung growth acceleration after fetal tracheal occlusion.J Pediatr Surg. 2002; 37 ([discussion 1007-10]): 1007-1010
- Hyperoncotic enhancement of pulmonary growth after fetal tracheal occlusion: a comparison between dextran and albumin.J Pediatr Surg. 2004; 39 ([discussion 324-8]): 324-328
- Experimental fetal tracheal ligation prevents the pulmonary hypoplasia associated with fetal nephrectomy: possible application for congenital diaphragmatic hernia.J Pediatr Surg. 1993; 28 ([discussion 1439-40]): 1433-1439
- Assessment of fetal lung maturity.Am Coll Obstet Gynecol Educ Bull. 1996; 230: 5
- Serum and urine albumin: a progress report on their measurement and clinical significance.Clin Chim Acta. 1997; 258: 3-20
- Developmental regulation of angiotensin converting enzyme and angiotensin type 1 receptor in the rat pulmonary circulation.Am J Respir Cell Mol Biol. 1996; 14: 526-537
- Quantitative methods in the study of pulmonary pathology.Thorax. 1962; 17: 320-328
- Experimental fetal tracheal ligation and congenital diaphragmatic hernia: a pulmonary vascular morphometric analysis.J Pediatr Surg. 1995; 30 ([see comments]) ([discussion 923-4]): 917-923
- Experimental fetal tracheal ligation reverses the structural and physiological effects of pulmonary hypoplasia in congenital diaphragmatic hernia.J Pediatr Surg. 1994; 29 ([discussion 256-7]): 248-256
- Congenital diaphragmatic hernia: the hidden morbidity.J Pediatr Surg. 1994; 29 ([discussion 262-4]): 258-262
- Pulmonary morbidity in 100 survivors of congenital diaphragmatic hernia monitored in a multidisciplinary clinic.J Pediatr Surg. 2001; 36: 133-140
- Analysis of an improved survival rate for congenital diaphragmatic hernia.J Pediatr Surg. 2003; 38: 729-732
- A morphologic and morphometric analysis of fetal lung development in the sheep.Anat Rec. 1981; 201: 655-667
- Pulmonary development in the fetal lamb: morphometric study of the alveolar phase.Anat Rec. 1991; 229: 495-498
- Lung development and fetal lung growth.Paediatr Respir Rev. 2004; 5: S259-S264
- Albumin products.Semin Thromb Hemost. 1980; 6: 85-120
- Osmolality and oncotic pressure of volume expanding fluids for newborn administration.Crit Care Med. 1982; 10: 863-864
- Absorption of intact albumin across rat alveolar epithelial cell monolayers.Am J Physiol Lung Cell Mol Physiol. 2003; 284: L458-L465
☆SMK was supported by grants from the NIH National Research Service Award DK065406-02 and the VH Kazanjian Surgical Research Fellowship of the Massachusetts General Hospital.
© 2006 Elsevier Inc. Published by Elsevier Inc. All rights reserved.