Physiologically based cord clamping stabilises cardiac output and reduces cerebrovascular injury in asphyxiated near-term lambs
| Autor: | Martin Kluckow, Andrew W. Gill, Douglas A Blank, Stuart B. Hooper, Vanesa Stojanovska, Suzanne L. Miller, Domenic A. LaRosa, Arjan B. te Pas, Graeme R. Polglase, Samantha K. Barton |
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| Jazyk: | angličtina |
| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Cardiac output Resuscitation Time Factors Real-Time Polymerase Chain Reaction Umbilical Cord 03 medical and health sciences 0302 clinical medicine 030225 pediatrics Internal medicine medicine Animals Arterial Pressure Oximetry Cardiac Output Asphyxia Asphyxia Neonatorum Sheep Spectroscopy Near-Infrared medicine.diagnostic_test business.industry Obstetrics and Gynecology General Medicine Oxygenation medicine.disease Constriction Immunohistochemistry Ventilation Perinatal asphyxia Cerebrovascular Disorders Pulse oximetry Blood pressure Animals Newborn Cerebrovascular Circulation Pediatrics Perinatology and Child Health Breathing Cardiology Female medicine.symptom business 030217 neurology & neurosurgery |
| Zdroj: | Archives of disease in childhood. Fetal and neonatal edition, 103(6), F530-F538 |
| Popis: | BackgroundPhysiologically based cord clamping (PBCC) has advantages over immediate cord clamping (ICC) during preterm delivery, but its efficacy in asphyxiated infants is not known. We investigated the physiology of PBCC following perinatal asphyxia in near-term lambs.MethodsNear-term sheep fetuses (139±2 (SD) days’ gestation) were instrumented to measure umbilical, carotid, pulmonary and femoral arterial flows and pressures. Systemic and cerebral oxygenation was recorded using pulse oximetry and near-infrared spectroscopy, respectively. Fetal asphyxia was induced until mean blood pressure reached ~20 mm Hg, where lambs underwent ICC and initiation of ventilation (n=7), or ventilation for 15 min prior to umbilical cord clamping (PBCC; n=8). Cardiovascular parameters were measured and white and grey matter microvascular integrity assessed using qRT-PCR and immunohistochemistry.ResultsPBCC restored oxygenation and cardiac output at the same rate and in a similar fashion to lambs resuscitated following ICC. However, ICC lambs had a rapid and marked overshoot in mean systemic arterial blood pressure from 1 to 10 min after ventilation onset, which was largely absent in PBCC lambs. ICC lambs had increased cerebrovascular injury, as indicated by reduced expression of blood–brain barrier proteins and increased cerebrovascular protein leakage in the subcortical white matter (by 86%) and grey matter (by 47%).ConclusionPBCC restored cardiac output and oxygenation in an identical time frame as ICC, but greatly mitigated the postasphyxia rebound hypertension measured in ICC lambs. This likely protected the asphyxiated brain from cerebrovascular injury. PBCC may be a more suitable option for the resuscitation of the asphyxiated newborn compared with the current standard of ICC. |
| Databáze: | OpenAIRE |
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