Late administration of antenatal vitamin A promotes pulmonary structural maturation and improves ventilation in the lamb model of congenital diaphragmatic hernia

Abstract

The lungs in congenital diaphragmatic hernia (CDH) are hypoplastic and immature making respiratory support one of the most challenging aspects of caring for these neonates. Vitamin A is essential for normal lung growth and development. It also promotes alveolarization. The aim of this study is to investigate the effects of antenatal vitamin A on lung growth and alveolarization and ventilation in the lamb model of CDH. This study was approved by the Animal Care Committee of the State University of New York at Buffalo, and conforms to the National Institute of Health guidelines. Diaphragmatic defects were created at 79-81days gestation. Group 1 lambs (CDH, n=5) were untreated. In group 2 (CDH+vitamin A, n=6) and group 3 lambs (control+vitamin A, n=3) right jugular venous catheters were inserted at 118-120days and retinyl palmitate (vitamin A) was administered until 135days. The control group (n=5) consisted of twin littermates. Lambs were delivered at 136-139days and ventilated for 2h according to a set protocol. The left lungs were harvested and fixed for histology. Lung compliance was significantly higher in CDH+vitamin A (median 0.27, range 0.1-0.48ml/cmH(2)O/kg) versus CDH lambs (median 0.07, range 0.07-0.18ml/cmH(2)O/kg), P<0.05. At 1h CDH+vitamin A lambs experienced significantly lower PaCO(2) (median 115, range 35-194mmHg vs. median 192, range 168-234mmHg) and higher arterial pH (median 7.0, range 6.74-7.35 vs. median 6.73, range 6.5-6.81) than CDH lambs, P<0.05. The lung weight to body weight ratio of CDH+vitamin A lambs was significantly less than that of CDH lambs (P<0.05). Histology showed small thick walled air-spaces and no true alveoli in CDH lambs. In contrast, true alveoli and thinning of the inter-alveolar septums were seen in CDH+vitamin A lambs. This is the first study to demonstrate an improvement in lung function and structural maturation when antenatal vitamin A is given in a surgical model of CDH.