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Effects of Postnatal Estradiol and Progesterone Replacement in Extremely Preterm Infants

Section of Neonatology and Pediatric Critical Care Medicine, Children’s Hospital (T.K.), Clinical Pharmacy (L.M.), and the Department of Obstetrics and Gynecology (H.-J.G.), University of Ulm, 89075 Ulm, Germany

Address all correspondence and requests for reprints to: Dr. A. Trotter, Section of Neonatology and Pediatric Critical Care Medicine, Children’s Hospital, University of Ulm, Prittwitzstrasse 43, 89075 Ulm, Germany. E-mail: andreas.trotter{at}medizin.uni-ulm.de

The fetus is supplied from the placenta with estradiol (E₂) and progesterone (P) in increasing amounts during gestation. After delivery of a premature infant, placental supply is disrupted, resulting in a rapid decrease in E₂ and P. Replacement of these placental hormones may restore intrauterine conditions and may be beneficial for bone mineral accretion, clinical course, and outcome. Thirty female infants with a median gestational age of 26.6 weeks (between 24.1–28.7) and a birth weight of 675 g (370–990) were randomized to receive E₂ and P replacement, aiming to maintain plasma levels equaling the intrauterine levels, or no replacement. The E₂ and P replacement was started iv and was followed by transepidermal administration for a total duration of 6 weeks. Repeated measurements included plasma levels of E₂, P, FSH, and LH; uterine volume; calcium and phosphorus in spot urine specimens; and bone mineral accretion by single photon absorption densitometry. Further, the incidence of chronic lung disease and various clinical outcome data were recorded. The plasma levels of E₂ and P were within the intrauterine range with median replacements of 2.30 mg/kg·day E₂ (1.13–6.23) and 21.20 mg/kg·day P (11.23–27.36), iv. Three- and 6-fold higher doses of E₂ and P were needed via the transepidermal route. The uterine volumes increased, and FSH and LH as indicators for biological effectiveness were significantly lowered with replacement. The bone mineral accretion rates tended to be higher, and the incidence of chronic lung disease tended to be lower (0% vs. 29%; P = 0.097). E₂ and P replacement via iv and transepidermal routes is capable of maintaining plasma levels as high as those in utero with biological effectiveness. Trends toward improved postnatal bone mineral accretion and less chronic lung disease were found with the hormone replacement. Further and more extensive studies are warranted to address the role of this new approach in the care of extremely premature infants.

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