McLeod JS, Church JT, Yerramilli P, Coughlin MA, Perkins EM, Rabah R, Bartlett RH, Rojas-Pena A, Greenson JK, Perrone EE, Mychaliska GB. Gastrointestinal mucosal development and injury in premature lambs supported by the artificial placenta.
J Pediatr Surg 2018;
53:1240-1245. [PMID:
29605266 PMCID:
PMC5994371 DOI:
10.1016/j.jpedsurg.2018.02.092]
[Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 02/27/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND
An Artificial Placenta (AP) utilizing extracorporeal life support (ECLS) could revolutionize care of extremely premature newborns, but its effects on gastrointestinal morphology and injury need investigation.
METHODS
Lambs (116-121days GA, term=145; n=5) were delivered by C-section, cannulated for ECLS, had total parenteral nutrition (TPN) provided, and were supported for 7days before euthanasia. Early and Late Tissue Controls (ETC, n=5 and LTC, n=5) delivered at 115-121days and 125-131days, respectively, were immediately sacrificed. Standardized jejunal samples were formalin-fixed for histology. Crypt depth (CD), villus height (VH), and VH:CD ratios were measured. Measurements also included enterocyte proliferation (Ki-67), Paneth cell count (Lysozyme), and injury scores (H&E). ANOVA and Chi Square were used with p<0.05 considered significant.
RESULTS
CD, VH, and VH:CD were similar between groups (p>0.05). AP demonstrated more enterocyte proliferation (95.7±21.8) than ETC (49.4±23.4; p=0.003) and LTC (66.1+11.8; p=0.04), and more Paneth cells (81.7±17.5) than ETC (41.6±7.0; p=0.0005) and LTC (40.7±8.2, p=0.0004). Presence of epithelial injury and congestion in the bowel of all groups were not statistically different. No villus atrophy or inflammation was present in any group.
CONCLUSIONS
This suggests preserved small bowel mucosal architecture, high cellular turnover, and minimal evidence of injury.
STUDY TYPE
Research paper/therapeutic potential.
LEVEL OF EVIDENCE
N/A.
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