Search

Objectives To document the maternal and fetal cord blood levels of human epididymis protein 4 (HE-4) in term and preterm newborns in order to investigate the possible physiological role of HE-4 in fetal lung development. Methods This cross-sectional study was conducted in a university-affiliated hospital between April 2018 and September 2018. The study population consisted of cesarean section (C-section) deliveries after 24 weeks of pregnancy. Both maternal and umbilical cord HE-4 levels (mHE-4 and uHE-4, respectively) were measured using chemiluminescent microparticle immunoassay. Amniotic fluid was sampled from each case to determine the lamellar body count (LBC) as the gold standard test for lung maturation. All the parameters, including the uHE-4 levels, were compared between the term delivery (≥37 weeks) (n=52) and preterm delivery (24–37th weeks) (n=30) groups. The best cut-off value of uHE-4 was calculated for fetal lung maturity. Results There were no statistically significant differences between the groups regarding the demographic data. The mHE-4 levels did not statistically significantly differ between the groups (p>0.05) whereas the uHE-4 level of the preterm newborns was significantly higher than that of the term newborns (p Conclusions Although the exact physiological role of HE-4 has not yet been elucidated, this preliminary study supports the idea that HE-4 plays a role in fetal lung maturation to some extent.

Made available in DSpace on 2020-12-12T01:45:23Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-01-01. Added 1 bitstream(s) on 2021-07-15T14:37:59Z : No. of bitstreams: 1 S0100-736X2019000800600.pdf: 990426 bytes, checksum: f9e3add90b459ca1ea262b7dcb029ae5 (MD5) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Considering the representativeness of dairy cattle in our country, the concern about the mortality rates of the animals increases each time. Regarding to calf mortality, the Respiratory Distress Syndrome (RDS) has an important relevance during the neonatal period, and it is present in immature lungs. The amniotic fluid is in direct contact with the fetus, and it is able to offer evidence about his maturity. The aim of this study was to standardize the characteristics of the amniotic fluid, color, aspect, viscosity, quantification of lamellar body and surfactant evaluation by the Clements test and cytology, of term-born, mature and healthy calves. There were used 50 Black and White Holstein calves, which mothers were observed at calving in order to collect the amniotic fluid by puncture in the moment of exposure of the fetal membrane through the vaginal canal. Most amniotic fluid had a clear and hazy appearance due to varying degrees of viscosity and the presence or absence of clots. The Clements test could be adapted to the bovine species by the modification consisting in the addition of 3mL of amniotic fluid and 1mL of 95% ethanol. The methodology of the lamellar body count by the automated particle counter is not applicable for the bovine because of the small size of their lamellar body. The Nile Blue staining is unsatisfactory on predicting fetal maturity on the bovine species, different from cytology using Hematoxylin-Shorr stain. The presence of orange cells, increase in large amounts at the end of pregnancy. The cell stained orange counting, cells which are found in great amounts at the end of pregnancy. The present study stablished new parameters for evaluation of fetal and pulmonary maturity in the bovine species. Departamento de Clínica Veterinária Faculdade de Medicina Veterinária e Zootecnia (FMVZ) Universidade Estadual Paulista (Unesp), Distrito de Rubião Júnior s/n Departamento de Cirurgia e Anestesiologia Veterinária Faculdade de Medicina Veterinária e Zootecnia (FMVZ) Universidade Estadual Paulista (Unesp) Campus de Botucatu Distrito de Rubião Júnior s/n Departamento de Clínica Médica Faculdade de Medicina Veterinária e Zootecnia (FMVZ) Universidade de São Paulo (USP) Cidade Universitária, Av. Dr. Orlando Marques de Paiva 87 Departamento de Clínica Veterinária Faculdade de Medicina Veterinária e Zootecnia (FMVZ) Universidade Estadual Paulista (Unesp), Distrito de Rubião Júnior s/n Departamento de Cirurgia e Anestesiologia Veterinária Faculdade de Medicina Veterinária e Zootecnia (FMVZ) Universidade Estadual Paulista (Unesp) Campus de Botucatu Distrito de Rubião Júnior s/n FAPESP: 2012/24836-8

Made available in DSpace on 2021-06-25T10:58:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-12-01. Added 1 bitstream(s) on 2021-07-15T14:35:56Z : No. of bitstreams: 1 S0100-736X2020001201039.pdf: 3041931 bytes, checksum: 9b717136f14b98809111f44afce14c21 (MD5) The aim of this study was to evaluate the lung maturity of premature and full-term lambs by analyzing amniotic fluid using the following methods: Clements test, Nile blue cytology test, hematoxylin-Shorr stain, lamellar body count, and radiographic tests. The use of these methods is intended to identify high-risk newborns and provide immediate clinical intervention after birth. Altogether, 56 animals (24 ewes and 32 lambs) were included in the study and divided into 3 groups. Group I consisted of 8 ewes that were at approximately 145 days of gestation; this group delivered 10 lambs naturally. Group II consisted of 8 ewes that were at 138 days' gestation; this group delivered 11 lambs by cesarean section. Group III consisted of 8 ewes at 138 days' gestation; this group was administered intramuscular dexamethasone (16mg/animal) 36 hours prior to a cesarean section. Group III delivered11 lambs. Cytological tests were performed using a microscope with a maximum magnification of 1000x, while the Clements test was visually observed by one of the researchers. Amnioticfluid lamellar body counts were measured using transmission electron microscopy. Among the staining methods, hematoxylin-Shorr was reliable, and Group III had a greater number of orangeophilic cells when compared to Group II, probably due to corticoid administration. The Clements test showed pulmonary maturity in approximately 20% of Group I lambs and Group II showed 9.1% of bubbles; however, Group III had the highest pulmonary maturity percentage (36.4%). The lamellar bodies were measured, and all groups had sizes between 0.019 and 0.590µm. Radiographic evaluation revealed that the majority of lambs presented some level of pulmonary radiodensity, indicating an acinar pattern at birth. These results are in line with the expectations of each group. We found that the normal group showed greater pulmonary maturity, whereas Group II presented pulmonary immaturity, which is expected because this group comprised lambs born prematurely and Group III showed pulmonary. Graduate Program in Animal Science Departamento de Clínica Cirurgia e Reprodução Animal Faculdade de Medicina Veterinária Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp) Campus Araçatuba, Rua Clóvis Pestana 793, Jardim Dona Amélia Faculdade de Ciências Agrárias Andradina (FCAA) Fundação Educacional de Andradina (FEA), Rua Amazonas 571 Universidade Federal de Mato Grosso do Sul (UFMS) Cidade Universitária, Av. Costa e Silva s/n, Pioneiros Veterinarian Universidade Federal de Juiz de Fora (UFJF) Campus Universitário, Rua José Lourenço Kelmer s/n Universidade Federal de Juíz de Fora (UFJF) Campus Universitário, Rua José Lourenço Kelmer s/n Graduation in Veterinary Medicine Faculdade de Medicina Veterinária Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp) Campus Araçatuba, Rua Clóvis Pestana 793, Jardim Dona Amélia Departamento Clínica Cirurgia e Reprodução Animal Faculdade de Medicina Veterinária Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp) Campus Araçatuba, Rua Clóvis Pestana 793, Jardim Dona Amélia Graduate Program in Animal Science Departamento de Clínica Cirurgia e Reprodução Animal Faculdade de Medicina Veterinária Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp) Campus Araçatuba, Rua Clóvis Pestana 793, Jardim Dona Amélia Graduation in Veterinary Medicine Faculdade de Medicina Veterinária Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp) Campus Araçatuba, Rua Clóvis Pestana 793, Jardim Dona Amélia Departamento Clínica Cirurgia e Reprodução Animal Faculdade de Medicina Veterinária Universidade Estadual Paulista Júlio de Mesquita Filho (Unesp) Campus Araçatuba, Rua Clóvis Pestana 793, Jardim Dona Amélia

The poorly understood tolerance toward high tidal volume (VT) ventilation observed in critically ill children and age-equivalent animal models may be explained by surfactant homeostasis. The aim of our prospective animal study was to test whether high VT with adequate positive end-expiratory pressure (PEEP) is associated with surfactant de novo synthesis and secretion, leading to improved lung function, and whether extreme mechanical ventilation affects intracellular lamellar body formation and exocytosis. Rats (14 days old) were allocated to five groups: nonventilated controls, PEEP 5 cmH2O with VT of 8, 16, and 24 mL/kg, and PEEP 1 cmH2O with VT 24 mL/kg. Following 6 h of ventilation, lung function, surfactant proteins and phospholipids, and lamellar bodies were assessed by forced oscillation technique, quantitative real-time polymerase chain reaction, mass spectrometry, immunohistochemistry, and transmission electron microscopy. High VT (24 mL/kg) with PEEP of 5 cmH2O improved respiratory system mechanics and was not associated with lung injury, elevated surfactant protein expression, or surfactant phospholipid content. Extreme ventilation with VT 24 mL/kg and PEEP 1 cmH2O produced a mild inflammatory response and correlated with higher surfactant phospholipid concentrations in bronchoalveolar lavage fluid without affecting lamellar body count and morphology. Elevated phospholipid concentrations in the potentially most injurious strategy (VT 24 mL/kg, PEEP 1 cmH2O) need further evaluation and might reflect accumulation of biophysically inactive small aggregates. In conclusion, our data confirm the resilience of infant rats toward high VT-induced lung injury and challenge the relevance of surfactant synthesis, storage, and secretion as protective factors.

Background The pulmonary surfactant especially lipids in amniotic fluid can reflect the development stage of fetal lung maturity (FLM). However, the conventional lecithin/sphingomyelin (L/S) ratio method by thin layer chromatography (TLC) is insufficient and inconvenient for FLM prediction in clinical practice. Methods The amniotic fluid samples were collected from the pregnant women in labor or undergoing amniocentesis and analyzed for its lipid contents with the liquid chromatography coupled with high‐resolution mass spectrometry (LC‐HRMS) method and the lamellar body count (LBC) method. To reveal the lipidomic profiling of different FLM stages, three groups of amniotic fluid samples including 8 from premature group (gestational week (GW) 38) were compared with the control group (n = 6) of 18 GWs separately. Results In the FLM prediction study, the sensitivity of the LC‐HRMS method and LBC method was 91% and 73%, respectively; the specificity was 100% and 95%, respectively. The most significant metabolic pathway was linoleic acid metabolism between the premature group and the control group. Both glycerophospholipid metabolism and glycosylphosphatidylinositol‐anchor biosynthesis were enriched in the mature groups. In search of potential FLM prediction markers in amniotic fluid, 8 phosphatidylcholines, 1 sphingomyelin, and 1 phosphatidylethanolamine were significantly increased in the mature groups compared with the premature group. Conclusion An efficient LC‐HRMS method for L/S ratio in predicting FLM was established. The linoleic acid metabolism may play an important role in the fetal lung development.

Objective During the last decade, guidelines published by the American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal Fetal Medicine (SMFM) have emphasized an increasingly limited role for fetal lung maturity (FLM) testing. As a reference laboratory for FLM testing, we were therefore interested in determining the impact of changing guidelines on our test volumes. Methods We retrospectively reviewed FLM test volume data from 2006 to 2016 for the following FLM assays: lecithin/sphingomyelin ratio, phosphatidylglycerol , disaturated lecithin , and lamellar body count. Results We found that there was a precipitous decline in test volumes from 2006 to 2016; our analysis led us to discontinue providing reference laboratory FLM testing in 2016 given the very low volumes. Conclusions The 2019 ACOG guidelines now state that FLM testing no longer has clinical utility. Therefore, clinical laboratory directors should meet with obstetrics providers to discuss discontinuation of FLM testing at their institutions.

Background It is not known if the endogenous surfactant pool available early in life is associated with the RDS clinical course in preterm neonates treated with CPAP. We aim to clarify the clinical factors affecting surfactant pool in preterm neonates and study its association with CPAP failure. Methods Prospective, pragmatic, blind, cohort study. Gastric aspirates were obtained (within the first 6 h of life and before the first feeding) from 125 preterm neonates with RDS. Surfactant pool was measured by postnatal automated lamellar body count based on impedancemetry, without any pre-analytical treatment. A formal respiratory care protocol based on European guidelines was applied. Clinical data and perinatal risk factors influencing RDS severity or lamellar body count were real-time recorded. Investigators performing lamellar body count were blind to the clinical data and LBC was not used in clinical practice. Results Multivariate analysis showed gestational age to be the only factor significantly associated with lamellar body count (standardized β:0.233;p = 0.023). Lamellar body count was significantly higher in neonates with CPAP success (43.500 [23.750–93.750]bodies/μL), than in those failing CPAP (20.500 [12.250–49.750] bodies/μL;p = 0.0003).LBC had a moderate reliability to detect CPAP failure (AUC: 0.703 (0.615–0.781);p

INTRODUCTION Predicting maturity of the foetal lung is extremely important in many obstetric situations as respiratory distress syndrome caused by surfactant deficiency remains one of the leading causes of neonatal morbidity and mortality. The need for predicting the foetal lung maturity by means of an accurate test which is done rapidly and available in majority of centres was the objective for this study. AIM To find out the optimum lamellar body count which correlates with foetal lung maturity and to compare the lamellar body count with shake bubble test. MATERIAL AND METHODS This prospective study was designed to evaluate the lamellar body count by standard haematology cell counter that is coulter counter and compare it with shake bubble test. Both the tests were done on 100 amniotic fluid samples in women with gestational age more than 28 weeks. Patients recruited were those who were sure of their last menstrual period (LMP), who were in active labour, and likely to deliver within 72 hours of collection of sample. Amniotic fluid samples obtained by transabdominal amniocentesis or by aspirating the forewaters per vaginum. Both shake bubble test and lamellar body count were done on the sample. RESULTS Lamellar body counts ranged from 10,000-2,43,000/microlitre and had a linear relationship with gestational age. The cut-off level of 30,000/microlitre was considered to be optimum to predict foetal lung maturity. Sensitivity and negative predictive value of lamellar body count at 30,000/microlitre and shake bubble test were comparable at 91.7%/91.7% and 97.3/96.6% respectively whereas with respect to specificity and positive predictive value, lamellar body count was superior to shake bubble test at 93.4%/73.7% and 81.5%/50%. CONCLUSION Lamellar body count is a rapid, inexpensive, simple and more reliable test to assess foetal lung maturity

Objective: The current study aims to compare the ultrasonographic evaluation of fetal lung Gray-level histogram width (GLHW) ratio with an amniotic fluid lamellar body count (LBC) in the prediction of fetal lung maturity. Methods: A prospective cohort study was conducted at a tertiary University Hospital in the period between May 1, 2017 and March 31, 2018. The study included pregnant women with a single fetus at ≥37 weeks of gestation scheduled for delivery by elective cesarean section (CS). Ultrasound evaluation was performed for assessment of the fetal lung to liver GLHW ratio to predict lung maturity. Lamellar body count was determined from an amniotic fluid sample obtained via amniotomy during CS. The lamellar body count for this sample was measured using a hematology analyzer. These data were further compared to Apgar scores at 1 and 5 minutes after delivery to assess the condition of the newborn immediately after birth, the degree of respiratory distress syndrome (RDS) and the need for resuscitation. Results: One hundred twenty women and their neonates were included in the study. There was a statistically significant decrease in the levels of both GLHW and LBC among those neonates that showed distressed respiration after Apgar testing as compared with those who did not show similar distress, with p-value

Background Twin pregnancies have a higher rate of preterm births, making precise prediction of neonatal respiratory disorders essential. We herein examined the amniotic lamellar body count (LBC) and found it to be an accurate predictor of respiratory disorders in twin pregnancies. Methods Five hundred fourteen amniotic fluid samples, comprising 132 dichorionic twin (DCT) and 125 monochorionic twin (MCT) gestations, were obtained at cesarean section performed at 29 to 38 gestational weeks. Samples were analyzed immediately without centrifugation. Results There were 26 neonates (5.1%) with respiratory distress syndrome (RDS) and 43 (8.4%) with transient tachypnea of the newborn (TTN). The LBC in neonates with TTN (5.12 × 104/μl) was between the counts in RDS (1.26 × 104/μl) and controls (10.6 × 104/μl), which differed significantly. Twin concordance rates were significantly higher for TTN in MCT gestations than DCT gestations (p = 0.003) and delta LBC value was significantly smaller in MCT (3.15 ± 0.4 × 104/μl) than DCT (5.17 ± 0.5 × 104/μl) gestations (p = 0.003). Conclusions The amniotic LBC is useful for predicting respiratory disorders, including RDS and TTN, in twin pregnancies. The data in this study may indicate a genetic predisposition to TTN among MCTs.

Background : Lamellar bodies are produced by pneumocyte type II cells in the lung alveoli. Lamellar bodies are present in amniotic fluid in increasing quantities as gestation advances, 1 – 5 µm in size, similar in size to small platelets and can be counted on most electronic cell counters in hematology analyzer. Lamellar body count is useful for prediction of fetal lung maturity and neonatal respiratory distress syndrome. The current gold standard for determination of fetal lung maturity is the evaluation of phospholipids in amniotic fluid samples by thin-layer chromatography, but it is time-consuming and not continuously available at most institutions. In this study we compare Cell Dyn Emerald and Cell Dyn Ruby method, which is expected to be a review for lamellar body count method. Purpose : The aim of this study was to analyze lamellar body count with Cell Dyn Emerald and Cell Dyn Ruby method on preterm birth. Methods : This was a cross sectional study. Thirty three samples study were inpatient’s amniotic fluid with premature rupture of membranes in Obstetry and Gynecology ward emergency room Dr. Soetomo Hospital Surabaya. Lamellar body count was counted with Cell Dyn emerald and Cell Dyn Ruby method. The statistical differences were assessed using the ANOVA test . Results : The results showed significant differences (t=49,04), lamellar body count with Cell Dyn Ruby method was much lower than Cell Dyn Emerald method. The lowest result with Cell Dyn Ruby method was 3.38 x 10 3 /µL and 17 x 10 3 / µL with Cell Dyn Emerald method. The highest results with Cell Dyn Ruby method was 98,2 x 10 3 / µL and 221 x 10 3 / µL with Cell Dyn Emerald method. Conclusion : Lamellar body count with impedance method (Cell Dyn Emerald) is significantly higher than optic method (Cell Dyn Ruby).

Human lysophosphatidylcholine acyltransferase 1 (hLPCAT1) is a protein which helps produce surfactant in the fetal lung. We previously reported that levels of cell-free fetal mRNA for hLPCAT1 in amniotic fluid are correlated with lamellar body count (LBC) (r2=0.93). This short communication demonstrates that fetal hLPCAT1 mRNA is also present in maternal blood. Its quantity also correlates with amniotic fluid LBC (r2=0.81). Research in maternal plasma hLPCAT1 may assist in understanding fetal and placental maturational processes.

Respiratory distress syndrome causes morbidity and mortality of the newborn and is most often associated with premature birth. Laboratory testing can be helpful in establishing fetal lung maturity (FLM) status in situations when premature delivery may be necessary. In addition, the rising incidence of late-preterm births at >34 and =50 k/mm3.

The aim of this study was prediction the fetal lung maturity by ultrasonic markers and comparison by lamellar body count and fetal outcome.A prospective Longitudinal study Department of perinatology of performed Emam Khomeini hospital and Mirza Kochak Khan Hospital in Tehran, Iran from March 2013 to January 2014. 100 pregnant women (37-40 weeks of gestation) who were admitted for elective cesarean section and referred for an obstetric ultrasound scan at the same day of their elective cesarean section were included. Scanning with linear ultrasound with convex transducer frequency of 3.5 MHZ was utilized to measure the biparietal diameter, Amniotic fluid vernix and placental grading. Statistical analysis was performed using Spss version 20. Validity of the indicators compared with lamellar body count and fetal outcome.In this study, from 100 patients under study, 8 cases were hospitalized in NICU (neonatal intensive care unit) which all of them had LAMELAR BODY COUNT 14000 (10000-14000). There were 6 boys and 2 girls. In this study, there was no perinatal mortality.In study we used ultrasonic marker of fetal lung maturity and related this to lamellar body count and neo natal outcome. The ultrasonic marker of fetal lung maturity can reduce mortality and morbidity in neonate.

The aim of this study is to evaluate the performance of amniotic fluid lamellar body count (LBC) on the timing of elective caesarean delivery (CS) at ≥ 39 weeks. After allocating the study group (group I, transient tachypnoea of newborn (TTN), n = 14), an age-matched control group (group II, no TTN, n = 79) was selected for amniotic fluid LBC analysis. The median amniotic fluid LBC levels in group I were significantly lower than in the control group. Furthermore, the median values of mean lamellar body volume, median lamellar body distribution width and lamellar bodycrit in group I were also significantly lower than in group II. The best amniotic fluid LBC value to predict TTN was 40.15 × 10(3)/μl, with 82.3% sensitivity and 64.3% specificity. The favourable sensitivity and specificity values to predict the TTN for amniotic fluid LBC may suggest using it as an elective caesarean delivery-time scheduling marker.

Objectives To evaluate surfactant content and function through the lamellar body count (LBC) and stable microbubble test (SMT) in mechanically ventilated infants with severe acute viral bronchiolitis. Study design Controlled cross-sectional study of 32 infants receiving mechanical ventilation: 16 with a diagnosis of acute viral bronchiolitis and 16 with normal lungs. Tracheal fluid was collected and LBC was performed in an automated cell counter. Samples were kept frozen and thawed for testing. At the time of analysis, samples were diluted in a dithiothreitol solution, vortexed for 10 seconds, and aspirated by the cell counter. SMT was performed using the Pattle technique. Results In the bronchiolitis group, the median (IQR) LBC was significantly lower than in the control group: 130 000 (61 250-362 250) vs 518 000 (180 250-896 000) lamellar bodies/μL; P = .003. Median (IQR) SMT values were also significantly lower in the bronchiolitis group: 10 (2-13) vs 400 (261-615) microbubbles/mm 2 ; P Conclusions Infants with acute viral bronchiolitis have reduced surfactant content and function. We speculate that these simple tests may be useful to identify infants with bronchiolitis who would benefit from surfactant replacement therapy.

Respiratory distress syndrome is a major cause of neonatal morbidity and mortality that is most commonly caused by a deficiency in lung surfactant in premature infants. Therefore, laboratory tests were developed to measure the presence and/or concentration of lung surfactant in amniotic fluid in order to estimate maturity of the fetal lung. Although these tests were once widely employed, their utilization by physicians has decreased in recent years. Several studies have shown that demonstration of a mature fetal lung index by antenatal testing does not improve neonatal outcomes. Instead, decreased respiratory and nonrespiratory morbidities are most highly correlated with gestational age of the fetus. Therefore, fetal lung maturity testing may have passed the point of being clinically useful.

Objective: The study was designed to acquire the cut-off value for lamellar body count and its role in predicting the presence of Respiratory Distress Syndrome (RDS) in pregnancy with gestational age above 28 weeks. Method: Amniotic fluid specimens were collected by amniotomy during cesarean section from women with gestational age above 28 weeks. A haematology analyzer (Advia 120) was used to determine the lamellar body counts. We also performed foam stability test and observed the development of respiratory distress syndrome. Receiver operating characteristics curve was estimated to assess the threshold of lamellar bodies count that may predict the presence of Respiratory Distress Syndrome. Result: Fifty nine specimens were collected from woman with 29 - 42 weeks gestational age. The incidence of Respiratory Distress Syndrome was 15.3%. Area under the curve for lamellar body count was 0.94. Lamellar body count, with the best cut-off point of 50,000 cell/μl had sensitivity 89% and specifity 92% for predicting the presence of RDS, while the sensitivity of foam stability test was 67% and specificity was 90%. The negative predictive value of the lamellar body count was 98% slightly better than the negative predictive value of the foam stability test 94 %. Conclusion: Although both test are good predictor of RDS, lamellar body count has higher sensitivity and specificity. It also has more advantages as it only requires small amount of sample, fast, easy and more objective. [Indones J Obstet Gynecol 2012; 36-4: 176-80] Keywords: foam stability test, lamellar body, respiratory distress syndrome

Objective To determine the diagnostic accuracy of the surfactant adsorption test (SAT) as a predictor for the need for surfactant replacement therapy in neonates with respiratory distress syndrome (RDS). Study design Amniotic fluid samples were collected from 41 preterm neonates with RDS treated with continuous positive airway pressure (CPAP) and 15 healthy control term neonates. Purified porcine surfactant served as a further control. Lamellar bodies and lung ultrasound score were also measured in a subset of the neonates treated with CPAP. Surfactant was administered according to the European guidelines, and clinical data were collected prospectively. Surfactant activity was measured as adsorption at the air/liquid interface and given in relative fluorescent units (RFU). Results Surfactant activity differed among native porcine surfactant (median, 4863 RFU; IQR, 4405-5081 RFU), healthy term neonates (median, 2680 RFU; IQR, 2069-3050 RFU), and preterm neonates with RDS (median, 442 RFU; IQR, 92-920 RFU; P .0001). The neonates who failed CPAP had lower surfactant activity compared with those who did not fail CPAP (median, 92 RFU; IQR, 0-315 RFU vs 749 RFU; IQR, 360-974 RFU; P = .0002). Differences between groups were more evident beyond 20-30 minutes of fluorescence; the 30-minute time point showed the highest area under the curve (0.84; P .001) and the best cutoff level (170 RFU; specificity, 72%; sensitivity, 96%) for the prediction of CPAP failure. Surfactant activity at 30 minutes was significantly correlated with lamellar bodies ( r = 0.51, P = .006) and lung ultrasound score ( r = -0.39, P = .013). Conclusion This technique has the potential to be developed into a fast, simple-to-interpret clinical test. The SAT can reliably identify preterm infants with subsequent CPAP failure and shows promise as a screening test for surfactant replacement in preterm neonates.

Objective To evaluate surfactant production and function in term neonates with transient tachypnea of the newborn (TTN). Study design Samples of gastric aspirates collected within 30 minutes of birth from 42 term newborns with gestational age ≥37 weeks (21 patients with TTN and 21 control subjects), delivered via elective cesarean delivery, were analyzed with lamellar body count and stable microbubble test. Results Results of lamellar body counts and stable microbubble tests were significantly lower in the TTN group than in control subjects ( P = .004 and .013, respectively). Lamellar body counts were significantly lower in infants with TTN requiring oxygen for ≥24 hours after birth than in infants requiring oxygen for P = .029). When the cutoff point was 48 hours, the stable microbubble count was significantly lower in the group requiring oxygen for ≥48 hours than in the group requiring oxygen for P = .047). Conclusions Term infants with TTN had low lamellar body counts associated with decreased surfactant function, suggesting that prolonged disease is associated with surfactant abnormalities.

The lamellar body count (LBC) represents an alternative method to the TDx-FLM II (Abbott Laboratories, Abbott Park, IL), which is planned to be discontinued, for assessing fetal lung maturity. Our objective was to validate the LBC on 3 hematology analyzers (Coulter LH 750 and Coulter Ac·T diff2, Beckman Coulter, Brea, CA; and Sysmex XE-2100, Sysmex, Mundelein, IL) to serve as a template for other laboratories attempting to perform in-house validation. Intra-assay and interassay coefficients of variation ranged from 1.7% to 21.8% and 1.9% to 7.1%, respectively, and all analyzers demonstrated excellent linearity. Whole blood and meconium were shown to interfere with LBCs, and specimens with these contaminants should be tested using phosphatidyl glycerol. With a TDx-FLM II cutoff of 55 mg/g or more and an LBC cutoff of 50,000/μL or more for maturity, concordance between the TDx-FLM II and the LBC on all instruments was poor (

Background: Lamellar bodies are present in amniotic fluid and their quantity increases with increased gestational age. Preterm premature rupture of the membranes (P-PROM) is one of the most common complications of pregnancy and is a major cause of preterm deliveries and thus the important cause of RDS. Fetal pulmonary maturity can be assessed by direct or indirect measurement of surfactant phospholipids secreted by the fetal lungs into amniotic fluid. Lamellar body count (LBC) has been introduced as an alternative to other methods.Methods: The study’s prime aim is to establish LBC as a predictor of RDS in P-PROM. We included pregnant women with P-PROM and gestational age between 28 weeks and 37 weeks and singleton live pregnancy. The lamellar body counting from amniotic fluid was done with the use of a standard hematology cell counter, sysmex KX-21. There was statistically significant co-relation between lamellar body count and period of gestation (by applying ANOVA).Results: Lamellar body counts were significantly less in cases of RDS as compared to non RDS cases.Conclusions: LBC count was selected among all other tests because the test can be performed with equipment found in most clinical analysis laboratories and is reliable in predicting fetal lung maturity.

Objective. A lamellar body count (LBC) ≥50,000/μl is suggested to document fetal lung maturity (FLM). We sought to determine the LBC threshold for FLM with the Cell-dyn 4000 hematology analyser.Methods. We queried our database for patients who underwent LBC testing from 2001 to 2007. Included were deliveries between 35 and 38 weeks gestation with testing ≤7 days from delivery. We excluded twins, anomalies and cases of ruptured membranes. Data were analysed for sensitivity and specificity of predicting respiratory distress syndrome (RDS) and plotted on a receiver operating characteristic curve.Results. There were 209 patients meeting study criteria. Of these, 120 had diabetes. Five neonates experienced RDS, all born to non-diabetic mothers with LBC values ≤72,000/μl. At this value the sensitivity is 100%, false positive rate 18% and the p value is 0.0146.Conclusion. Our results question the 50,000/μl threshold and demonstrate the need for hematology analyser specific thresholds.

The aim of this study was to gather useful new data for evaluation of lung maturity in the neonatal foal. Because equine neonatal intensive therapy is very expensive, a precocious diagnosis could help to express a prognosis and to offer a respiratory support early after birth, increasing the survival rate and reducing complications. Amniotic fluid was collected at parturition on n=18 mares. Lamellar bodies were isolated in the amniotic fluid and measured with transmission electron microscopy (TEM). Furthermore two tests on amniotic fluid that are commonly used in humane medicine were utilized: lecithin/sphingomyelin ratio (L/S) and lamellar body count (LBC). L/S ratio was determined using thin layer chromatography (TLC) and, for the first time in equine amniotic fluid, with high performance liquid chromatography (HPLC). LBC was performed with an automated blood cell counter. The mean of the L/S ratio obtained in mature foals was 2.5 with TLC and 2.7 with HPLC. The mean LBC in the same group was 48x10(3)/microL. The Spearman's Rank correlation test found a significant correlation between TLC and Apgar score (R=0.66, p

Background The amniotic lamellar body count (LBC) is useful for predicting respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) in twin pregnancies. However, the risk of neonatal respiratory complications varies with gestational age (GA). We herein created a model to predict the risk for RDS and TTN using GA and the LBC in twin pregnancies. Methods Six hundred thirty-two amniotic fluid samples, comprising 169 dichorionic twin (DCT) and 147 monochorionic twin (MCT) gestations, were obtained at Cesarean section. The samples were analyzed immediately without centrifugation. A logistic regression model including the LBC and GA was used to develop the prediction model for RDS/TTN. Results There were 101 neonates (16.0%) with RDS/TTN. The GA and LBC were significant independent factors affecting RDS/TTN. According to the logistic regression model, we determined the probability of RDS/TTN given the values of GA and the LBC. The overall diagnostic accuracy for predicting neonatal RDS/TTN using GA and the LBC was higher than the use of the LBC alone. Conclusions GA-specific LBC cutoffs for the risk assessment of neonatal RDS/TTN have been considered to be more accurate in twin pregnancies. Our findings provide valuable, new information for the management of twin pregnancies.

Lysophosphatidylcholine acyltransferase 1 (LPCAT1) is required in the biosynthesis of pulmonary surfactant. This short communication describes our assessment of LPCAT1 mRNA levels in human amniotic fluid. We found a direct correlation between LPCAT1 mRNA copies and the amniotic fluid lamellar body count (LBC). This finding corroborates an association between LPCAT1 and surfactant phospholipid biosynthesis in humans. It may provide a model for future research in perinatal medicine.

Objectıve: To evaluatethe superiority of the most performed tests; lamellar body counts and TDxFLMtest compared to each other to estimate the maturation of fetal lungs and alsoto evaluate the reasons for the unclear cut-off values of lamellar body counts.Material and Method: Amnion fluids that were taken into 2 separate tubes from 56 patientswithin a year were evaluated with both of the tests. Newborns were evaluatedand monitored for respiratory distress syndrome of newborns by a neonatologistwho was blinded to the results of the amnion fluids. Clinical findings such asgrunting, tachypnea, retractions and cyanosis beginning within 6-8 hours afterbirth, oxygen need over 24 hours, arterial blood gas analyses with partialoxygen pressure under 50 mmHg and presence of chest x-ray findings that arecompatible with the situation were accepted as the respiratory distress ofnewborns.Results: Respiratory distress was not seen in 44 of the 56 newborns while it wasseen in 12 (21.4%) of them. In 30 patients whose lamellar body counts were >55000/mm3 without centrifuge, RDS was not seen. In the patientswhose lamellar body counts were 41, all cases can be detected.Conclusion: Count of lamellarbodies is adiagnostic tool which is fast, practical, easily accessible andcost-effective; also there is no doubt on the benefits of the tool. It seemsthat the different cut-off values have reasonable causes. Thus, we suggest thatevery clinic should have its own cut-off values. In the presence of interim results, additional evaluation with TDxFLM wasfound to increase the sensitivity and specificity. Key words: Respiratory distresssyndrome, lamellar body count, fetal lung maturity, Amaç: Fetal akciğer matürasyonunun değerlendirilmesinde en sık kullanılan testler olan lameller cisimcik sayımı ile TDxFLM testinin birbirlerine üstünlüklerinin incelenmesi ve lameller cisimcik sayımında halen netleşmeyen eşik değerinin nedenlerini araştırmak.Gereç ve Yöntem: Hastanemizde 1 yıl içinde 56 hastadan alınan amnion sıvıları 2 ayrı tüp ile her iki test açısından değerlendirildi. Yenidoğan bebekler test sonuçlarını bilmeyen bir neonatalog tarafından yenidoğan solunum sıkıntısı açısından değerlendirildi ve takip edildi. Doğum sonrası 6 ila 8 saat içinde başlayan takipne, inleme, çekilmeler ve siyanoz gibi bulgular, 24 saat üzerinde süren oksijen ihtiyacı, oksijen kısmi basıncı 50mm Hg’dan daha düşük arteryal kan gazı sonucu, klinik tablosu ile uyumlu akciğer filmi bulguları varlığı yenidoğan solunum sıkıntısı olarak kabul edildi.Bulgular: 56 yenidoğandan 44 tanesinde solunum sıkıntısı izlenmezken, 12 tanesinde (%21.4) yenidoğan solunum sıkıntısı tablosu gerçekleşmiştir. Lamellar cisimcik sayısı santrifüj edilmeden ölçülmesi sonrasında değer >55000 / mm³ olan 30 hastanın hiçbirinde RDS gelişmemiştir. Lamellar cisimcik 4 olarak tespit edildiğinde, olguların hepsini tespit etmekte, duyarlılığı ve özgüllüğü %100 seviyesine çıkarmaktadır.Sonuç: Lameller cisimcik sayımı; hızlı, pratik, kolay ulaşılabilir ve maliyet etkinlik açısından avantajları tartışılmaz bir tanı yöntemidir. Farklı eşik değerleri olmasının geçerli nedenleri olduğu gözlenmektedir. Bu nedenle her kliniğin kendi sınırlarını belirlemesinin gerekli olduğu sonucuna ulaşılmıştır.Ayrıca ara değerlerde kalınan durumlarda TDxFLM testi ile ilave değerlendirme yapılmasının duyarlılığı ve özgüllüğü arttırdığı belirlenmiştir.Anahtar kelimeler: Solunum sıkıntısı sendromu; lameller cisimcik sayımı; fetal akciğer matüritesi

Summary: In the process of maturation, alveolar epithelial cells produce surface-active material (surfactant) which consists mainly of phospholipids and, although to a significantly lesser degree, neutral lipids, proteins and carbohydrate. Pulmonary surfactant is synthesized in alveolar type-II granular pneumocytes and »packed« as lamellar bodies. Before delivery, the lamellar bodies diffuse through the bronchial tree into the amniotic fluid. Parameters which indicate the maturity of lungs, except the concentration of lamellar bodies, also are observed in the ratio against the quantity of surfactant with other components of the amniotic fluid (sphingomyelin and albumin). The study concerns the determination of the surfactant-to-albumin ratio and the lamellar body count in the amniotic fluid as predictors of fetal lung maturity. The research involved 90 pregnant women with gestational age from 32 to 40 weeks. The samples of the amniotic fluid were obtained by amniocentesis and they were filtrated through special filters. The surfactant-to-albumin ratio was measured by the Fetal Lung Maturity II (FLM) test, on a TDX instrument (ABBOTT). The concentration of lamellar body count was measured on a hematology cell counter by the platelet channel, on the Cell Dyn 3700 instrument (ABBOTT). The average value of S/A ratio was 55.11 mg/g (min=6.96 mg/g, max=112.00 mg/g). The surfactant-to-albumin ratio of less than 39.00 mg/g predicts respiratory distress syndrome with the probability of 92%. The average value of LB was 69.4 × 109/L (min=4.2 × 109/L, max=199.0 × 109/L). Lamellar body concentration of 34.0 × 109/L or less predicts respiratory distress syndrome with the probability of 93%. The surfactant to albumin ratio increased with gestation (r=0.373, p

Fetal lung maturity assessment in twin pregnancy has been discussed, but is still controversial. The purpose of this study is to predict the occurrence of respiratory distress syndrome (RDS) using lamellar body count (LBC) and analyze the validity of LBC for fetal lung maturity assessment in twin pregnancy. Three-hundred two amniotic fluid samples were obtained at cesarean section from 29 to 38 weeks of gestation. Samples were analyzed immediately with no centrifugation and the number of lamellar bodies was counted using a platelet channel on the Sysmex SF-3000. There were 18 neonates (6.0%) suffering from RDS. An LBC cut-off value of 2.95 × 104/μL resulted in 91.5% sensitivity and 83.3% specificity for predicting RDS. This cut-off value for predicting RDS was the same as that in singleton pregnancy. Moreover, the median LBC value in RDS cases was significantly lower than in non-RDS cases (1.50 ± 1.1 × 104/μL vs. 10.6 ± 7.5 × 104/μL; p < .001). This is the first report on the validity of LBC in twin pregnancy and also the largest study on fetal lung maturity assessment in twin pregnancy. An LBC value of >2.95 × 104/μL means reassuring findings for RDS even in twin pregnancy. We believe the data in this study provide valuable, new information for the management of twin pregnancies.