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Neonatology pp 73-94 | Cite as

Prenatal and Postnatal Inflammatory Mechanisms

  • Kirsten Glaser
  • Christian P. Speer
Reference work entry

Abstract

During the past 20 years, intrauterine infection and inflammation have been identified as significant risk factors in the development of fetal and neonatal morbidity and mortality, as well as adverse long-term outcome in very immature preterm infants. Besides severe infections, immature preterm infants are at high risk for syndromes of dysregulated inflammation including bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), and preterm cerebral white matter disease (WMD). Although pathogenesis is multifactorial, inflammation has been acknowledged as principle mechanism, being caused, sustained, and aggravated by multiple perinatal factors interacting in a multiple-hit sequence. An inflammatory state is presumed to be either initiated prenatally by chorioamnionitis or induced and sustained by pro-inflammatory postnatal conditions, such as oxygen toxicity, mechanical ventilation, and neonatal infection. Perturbation of pro- and anti-inflammatory central signaling pathways and subsequently imbalanced inflammatory responses may lead to severe organ injury affecting parenchymal development during a window of vulnerability. Maturation-dependent factors and genetic predisposition may underlie a particular vulnerability.

Abbreviations

BALF

Bronchoalveolar lavage fluid

BPD

Bronchopulmonary dysplasia

CA

Chorioamnionitis

CP

Cerebral palsy

CPAP

Continuous positive airway pressure

CSF

Cerebrospinal fluid

ELBW

Extremely low birth weight

EOS

Early-onset sepsis

FIRS

Fetal inflammatory response syndrome

ICAM

Intercellular adhesion molecules

IFN-γ

Interferon-y

IL

Interleukin

IL-1ra

IL-1 receptor antagonist

IRAK

IL-1 receptor-associated kinase

LOS

Late-onset sepsis

LPS

Lipopolysaccharide (endotoxin)

MCP

Monocyte chemoattractant protein

MIP

Macrophage inflammatory protein

MMP

Matrix metalloproteinase

MRI

Magnetic resonance imaging

NF-KB

Nuclear transcription factor KB

PCR

Polymerase chain reaction

PMNs

Polymorphonuclear cells

Pre-OLs

Pre-myelinating oligodendrocytes

PRR

Pattern recognition receptor

RDS

Respiratory distress syndrome

ROS

Reactive oxygen species

SP

Surfactant protein

TGF-β

Transforming growth factor-β

TLR

Toll-like receptor

TNF-α

Tumor necrosis factor-α

VCAM

Vascular cell adhesion molecules

VEGF

Vascular endothelial growth factor

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University Children’s HospitalUniversity of WürzburgWürzburgGermany

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