ORIGINAL ARTICLE Maternal and cord serum lipid profiles of preterm infants with respiratory distress syndrome T Gunes, E Koklu and MA Ozturk Division of Neonatology, Department of Paediatrics, School of Medicine, Erciyes University, Kayseri, Turkey Background: Lipid metabolism has an important role in fetal development during the late stage of gestation, including growth and fat accretion in utero, increasing amniotic fluid lecithin levels with maturation of pulmonary function and changes in the levels of minor phospholipids in amniotic fluid. Objective: The aim of this study was to compare the maternal and cord lipid profiles of preterm infants with respiratory distress syndrome (RDS) and a control group without RDS. Method: The study groups consisted of 166 preterm infants with gestational ages ranging from 25 to 36 weeks, and birth weights ranging from 748 to 2495 g. Of these infants, 57 developed RDS and 109 infants served as controls. The infants were divided into four gestational age groups (34 to 36, 31 to 33, 28 to 30 and 25 to 27 weeks). Stepwise linear regression analyses were performed to determine independent contribution of each lipid parameter of the infants to their characteristics and mothers’ variables. Result: Total cholesterol, high-density and low-density lipoproteins (LDL) cholesterols levels were lower in infants with RDS and in their mothers than in controls, and maternal lipid profile was related to those of their infants (P<0.05). Pregravid body mass index (BMI) was related to triglyceride levels of the infants, and weight gain during pregnancy was related to LDL cholesterol levels of the infants (P <0.05). Conclusion: RDS is accompanied with lipid alteration in infants and their mothers. Pregravid BMI and weight gain during pregnancy might have a prognostic significance in the prediction of respiratory distress in early neonatal period. Journal of Perinatology (2007) 27, 415–421; doi:10.1038/sj.jp.7211775; published online 7 June 2007 Keywords: respiratory distress syndrome; cord; maternal; serum lipids Introduction Cholesterol was found to represent over 50% of the neutral lipid of both the total surfactant and the lamellar body fractions, and de novo synthesis of cholesterol from [1- 14 C]acetate accounted for only 1% of the surfactant cholesterol, the remainder being derived from exogenous cholesterol supplied as serum lipoproteins. 1 The function of cholesterol in surfactant has not been established; however, it is believed to facilitate spreading of dipalmitoylphosphatidylcholine at the air–liquid interface in the lung, lowering surface tension. 1,2 Hass et al. 3 suggested that lung cholesterol metabolism might be subject to regulation by both low-density lipoprotein (LDL) and high-density lipoprotein (HDL). The infants who subsequently developed respiratory distress had significantly lower lipoprotein levels than the levels in normal newborns and in preterm infants without respiratory distress after delivery. 4,5 Additionally several factors significantly affected cord serum levels, especially gestational age and birth weight. 4,5 Lipid metabolism has an important role in fetal development during the late stage of gestation, including growth and fat accretion in utero, transport of cholesterol to the fetal adrenal for hormone synthesis, increasing amniotic fluid lecithin levels with maturation of pulmonary function and changes in the levels of minor phospholipids in amniotic fluid. 6 A deficiency or reduced transport of essential and/or long-chain polyunsaturated fatty acids, which resulted in lipid alterations could inhibit normal fetal growth and maturation, one effect of which would be delayed development of the fetal lungs, which could lead to the respiratory distress syndrome (RDS) post-natally. Normal fetal growth is a positive function of gestational weight gain, modified by maternal prepregnancy body body mass index (BMI). 7 Both maternal prepregnancy weight and weight gain during gestation are important factors affecting fetal growth and birth weight. 8 The purpose of this study was to evaluate maternal and cord lipid profile in preterm infants with RDS compared to a control group without RDS. Materials and methods From 1 January to 1 December, 2005, a total of 1649 neonates were admitted to the neonatal intensive care unit. The inclusion criterion at admission was preterm infant whose gestational age is between 25 and 36 weeks. The exclusion criterion at admission were: being mature, a >36 weeks gestational age, small for Received 1 March 2007; accepted 30 April 2007; published online 7 June 2007 Correspondence: Dr E Koklu, Division of Neonatology, Department of Paediatrics, School of Medicine, Erciyes University, Kayseri, Turkey. E-mail: esad@erciyes.edu.tr Journal of Perinatology (2007) 27, 415–421 r 2007 Nature Publishing Group All rights reserved. 0743-8346/07 $30 www.nature.com/jp