Iijima Shigeo
Department of Neonatology, Toho University Medical Center, Tokyo, Japan.
BMC Pediatr. 2018 Feb 14;18(1):60. doi: 10.1186/s12887-018-1056-4.
Fetal adrenal gland size is known to have a positive correlation with both gestational age and estimated body weight. In contrast, some clinical observations suggest that maturation of the adrenal stress response occurs after 30 weeks of gestation. In this study, adrenal gland size at birth in extremely preterm to term neonates was investigated using ultrasonography to evaluate the adrenal developmental pattern and the impact of prematurity and perinatal factors.
The area of the right adrenal gland was measured in the first 3 h of life in 350 neonates and corrected for birth weight (BW) to determine the corrected adrenal area index (cAI). The neonates were subdivided into three groups: group 1 (before 30 weeks of gestation), group 2 (30 to 36 weeks), and group 3 (after 37 weeks). Differences in the cAI among the 3 groups were compared to estimate the impact of perinatal factors.
The adrenal gland size was measurable in all neonates with gestational age ranging from 23 to 41 weeks. Right adrenal gland area was highly correlated with BW (r = 0.75, p < 0.01). cAI showed a significant negative correlation with gestational age in group 1 (r = - 0.67, p < 0.01), whereas it showed no correlation with gestational age in both groups 2 and 3. As for the impact of perinatal parameters on cAI, only gestational age in group 1 and only fetal distress in group 2 were correlated with cAI. In group 3, perinatal parameters such as fetal distress and low Apgar score were correlated with cAI.
The present study demonstrated that the developmental pattern of fetal adrenal gland was different before and after 30 weeks of gestation, suggesting that the magnitude of adrenal stress response might mature after 30 weeks of gestation.
已知胎儿肾上腺大小与孕周和估计体重均呈正相关。相比之下，一些临床观察表明，肾上腺应激反应的成熟发生在妊娠30周之后。在本研究中，使用超声检查对极早产儿至足月儿出生时的肾上腺大小进行了调查，以评估肾上腺发育模式以及早产和围产期因素的影响。
在出生后3小时内测量了350例新生儿右肾上腺的面积，并根据出生体重（BW）进行校正，以确定校正后的肾上腺面积指数（cAI）。将新生儿分为三组：第1组（妊娠30周之前）、第2组（30至36周）和第3组（37周之后）。比较三组之间cAI的差异，以评估围产期因素的影响。
所有孕周在23至41周的新生儿肾上腺大小均可测量。右肾上腺面积与BW高度相关（r = 0.75，p < 0.01）。第1组中cAI与孕周呈显著负相关（r = -0.67，p < 0.01），而第2组和第3组中cAI与孕周均无相关性。至于围产期参数对cAI的影响，第1组中只有孕周与cAI相关，第2组中只有胎儿窘迫与cAI相关。在第3组中，胎儿窘迫和低Apgar评分等围产期参数与cAI相关。
本研究表明，胎儿肾上腺的发育模式在妊娠30周前后有所不同，提示肾上腺应激反应的程度可能在妊娠30周后成熟。
