MATURATION OF THE LUNGS

Up to 7
th
month:
-bronchioles divide continuously
-canalicular phase: more and smaller canals increase steadily
-vascular supply increase steadily

Terminal bronchioles

Divide to form

Respiratory bronchioles

Divides into 3-6

Alveolar ducts

Which end in


Terminal sacs (Primitive alveoli)
Surrounded by flat alveolar cells in close contact with
neighboring capillaries










By the end of 7
th
month:
-sufficient numbers of mature alveolar sacs and capillaries are
present to guarantee adequate gas exchange
-infant is able to survive.



During last 2 months of prenatal life:
(and for several years thereafter)
-number of terminal sacs increase steadily.
-cell lining the sacs (type I alveolar epithelial cells) become
thinner surrounding capillaries protrude into the alveolar sacs.
-intimate contact between epithelial and endothelial cells make up
the blood-air barrier.

*Mature alveoli are not present before birth

At the end of 6
th
month
-type II alveolar epithelial cells develop produce surfactant
-surfactant- phospholipid-rich fluid capable of lowering surface
tension at air-alveolar interface.

Before birth:
-lungs are full of fluid that contain:
*high chloride concentration
*little protein
*some mucus from the bronchial glands
*surfactant from type II alveolar epithelial cells

Amount of surfactant in the fluid increases particularly during the
last 2 weeks before birth.

Surfactant concentration increases
(during 34
th
week of gestation)



Phospholipids (in surfactant) enter the amniotic fluid



Act on macrophages in the amniotic cavity





As suggested by evidence:
Macrophages (when activated), migrate across the chorion into the
uterus




Where they begin to produce immune system proteins, including
interleukin-1B (IL-1B).




Upregulation of these proteins result in increased production of
prostaglandins cause uterine contractions.


Fetal breathing movements begin at birth cause aspiration of
amniotic fluid.

-These movements are important for stimulating lung development
and conditioning respiratory muscles.
-Most lung fluid rapidly resorbed by the blood and lymph
capillaries.
-Small amount probably expelled via the trachea and bronchi
during delivery.
-Surfactant remains deposited as the thin phospholipid coat on
alveolar cell membranes on first breath, prevents development of
an air-water (blood) interface with high surface tension prevent
atelectasis (alveolar collapse during expiration).

Clinical Correlates:
Surfactant
-particularly important for survival of premature infant.






-when insufficient, air-water (blood) surface membrane tension
becomes highhigh risk for atelectasis Respiratory Distress
Syndrome develops.

Respiratory Distress Syndrome
-previously hyaline membrane disease (partially collapsed alveoli
contain a fluid with high protein content, many hyaline
membranes, and lamellar bodies, probably derived from
surfactant layer.
-common cause of death in premature infant (20% of deaths among
newborns)
-Treatment: artificial surfactant (glucocorticoids) for preterm
babies as well as mothers to stimulate surfactant production
reduced mortality associated with RDS.

Some rare abnormalities of the lung (rare) and bronchial tree (more
common):
*blind-ending trachea with absence of lungs
*agenesis of one lung
*supernumerary lobules in the bronchial tree

-These variations have little functional significance but may cause
unexpected difficulties during bronchoscopies.

Ectopic lung lobes
-arise from the trachea or esophagus
-believed to be formed from additional respiratory buds of the
foregut that developed independent of the main respiratory system

Congenital cysts of the lung
-formed by dilation of terminal or larger bronchi
-may be small and multiple giving lungs honeycomb appearance
on radiograph or may be restricted to one or more larger ones
-usually drain poor and frequently cause chronic infections

Respiratory movements after birth:
-bring air into the lungs expand and fill the pleural cavity.
-due primarily to an increase in the number of respiratory
bronchioles and alveoli.
-only 1/6 of the adult number of alveoli are present at birth
-remaining alveoli are formed during first 10 years of postnatal life
through the continuous formation of new primitive alveoli.



Reference:
Langmans Medical Embryology (12
th
Edition) by T.W. Sadler