Abstract
The respiratory distress syndrome is believed to be due to insufficient surfactant. It is known that there is a greater incidence of the respiratory distress syndrome among infants delivered by cesarean section before labor than among those delivered after labor at the same gestational age. The purpose of this study was to determine the effect of labor on the production of pulmonary surfactant. We measured the phospholipid content of lung lavage in newborn rabbits delivered by cesarean section before labor at 29, 30, and 31 (full-term) days gestation and after oxytocin-induced labor at 31 days. We also measured the activities of pulmonary cholinephosphate cytidylyltransferase and choline-phosphotransferase, enzymes involved in the de novo synthesis of phosphatidylcholine, the major component of surfactant. There was a two- to fourfold increase in the amount of lung lavage phospholipid during the first 6 h after birth. This was not dependent upon gestational age at delivery. There was a further two- to fourfold increase in the next 18 h which was, however, dependent upon gestational age. Labor increased the amount of lavage phospholipid from rabbits delivered at full term by 132%, 177%, and 50% at 3, 6, and 24 h after birth, respectively. There was a postnatal increase in the activity of cholinephosphate cytidylyltransferase. This was almost linear with time during the first 12 h, by which time essentially adult values were attained. Choline-phosphate cytidylyltransferase was not affected by labor. There was also a postnatal increase in the activity of cholinephosphotransferase but this was stimulated 86%, 59%, and 21% by labor at 0, 1, and 24 h after birth, respectively. These studies suggest that labor stimulates both the synthesis and secretion of surfactant in the immediate postnatal period and thus may be an important factor in the prevention of the respiratory distress syndrome of the newborn.