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Review
. 2012 Oct;145(1):61-8.
doi: 10.1016/j.clim.2012.08.006. Epub 2012 Aug 17.

The developing human preterm neonatal immune system: a case for more research in this area

Ashish Arunkumar Sharma  1 , Roger Jen, Alison Butler, Pascal M Lavoie
Affiliations
Review

The developing human preterm neonatal immune system: a case for more research in this area

Ashish Arunkumar Sharma et al. Clin Immunol. 2012 Oct.

Abstract

Neonates, particularly those born prematurely, are among the most vulnerable age group for morbidity and mortality due to infections. Immaturity of the innate immune system and a high need for invasive medical procedures in the context of a preterm birth make these infants highly susceptible to common neonatal pathogens. Preterm infants who survive may also suffer permanent disabilities due to organ damage resulting from either the infection itself or from the inflammatory response generated under an oxidative stress. Infections in preterm infants continue to pose important healthcare challenges. Yet, developmental maturation events in the innate immune system that underlie their excessively high vulnerability to infection remain largely understudied. In this review article, we identify pertinent knowledge gaps that must be filled in order to orient future translational research.

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Figures

Figure 1
Figure 1
Developmental changes occurring in the human immune system early in life. This figure illustrates maturational events occurring in major adaptive and innate immune functions as the human transitions from a fetal tolerance state and becomes exposed to microorganisms as well as other environmental antigens de novo after birth. Adaptive immune functions [top panel]: Maternal transplacental antibody transfer (IgG) mainly occurs during late gestation, followed by maternal antibody protection (IgA) acquired through breast-milk after birth. Infants’ own antibody response become fully mature later during early childhood. Neonatal T cells are largely biased towards helper type II responses and humans display high proportions of T regulatory and Natural Killer T cells at birth [91]. Innate immune functions [bottom panel]: Pro-inflammatory (IL-1β, IL-6, TNF-α, IL-12, IL-23) and anti-viral (IFN-α) cytokine responses are largely attenuated in preterm infants, whereas production of the anti-inflammatory IL-10 cytokine is relatively high during late gestation and at birth.
Figure 2
Figure 2
Blood leukocyte count in preterm and term newborns and adults. Adapted from reference [18].
See this image and copyright information in PMC

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