Key result
Infant cord blood vasoactive peptide precursors exceed adult levels by ~70-fold, decreasing with gestational age.
Why the study?
The biological effectors of neurohormonal systems activated during birth are difficult to measure due to short half-life, instability, or low concentrations.
Cross-Sectional (n=119)
Vasoactive and natriuretic mediators are markedly elevated in umbilical cord blood, especially in preterm infants, suggesting a role in circulatory transition at birth.
Should not yet change neonatal practice; hypothesis-generating for vasoactive peptides in birth transition and needs prospective validation.
BACKGROUND: Though various neurohormonal systems are concurrently activated during birth, their biological effectors are not always easy to measure due to their short half-life in vivo, instability in biological samples, or very low concentrations. METHODS: Using a recently discovered chemiluminescence assay, we measured the stable precursor fragments mid-regional pro-atrial natriuretic peptide (MR-proANP), mid-regional pro-adrenomedullin (MR-proADM), C-terminal pro-endothelin-1 (CT-proET-1) and C-terminal pro-vasopressin (CT-proAVP or copeptin) immediately after birth in umbilical venous cord blood from 119 infants with a gestational age of 23-42 weeks and evaluated their possible functions. RESULTS: Cord blood levels of MR-proANP, MR- proADM, CT-proET-1, and CT-proAVP were considerably higher compared with normal adult levels. The CT-proAVP concentrations were 10-fold higher in term, and 70-fold higher in extremely preterm infants. MR-proANP showed 4-fold higher levels in term infants and 20-fold higher levels in extremely preterm infants. Levels of MR-proADM and CT-proET-1 were 2- to 3-fold higher in preterm and term infants. All four parameters showed significantly decreased values with increasing gestational age and a significant correlation between CT-proET-1 and MR-proADM. CONCLUSION: Our results indicate that vasoactive and natriuretic mediators play a functionally relevant role in circulatory transition from fetal to neonatal life.
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Koch et al. (2011) conducted a cross-sectional in Term and preterm infants (n=119). Gestational age vs. Normal adults was evaluated on Cord blood levels of MR-proANP, MR-proADM, CT-proET-1, and CT-proAVP. Cord blood levels of vasoactive peptide precursors were up to 70-fold higher in preterm and term infants compared to adults, and significantly decreased with increasing gestational age.
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