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Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord
The optimal timing of cord clamping in asphyxia is not known. Our aims were to determine the effect of ventilation (sustained inflation–SI vs. positive pressure ventilation–V) with early (ECC) or delayed cord clamping (DCC) in asphyxiated near-term lambs. We hypothesized that SI with DCC improves ga...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145980/ https://www.ncbi.nlm.nih.gov/pubmed/33946658 http://dx.doi.org/10.3390/children8050353 |
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author | Nair, Jayasree Davidson, Lauren Gugino, Sylvia Koenigsknecht, Carmon Helman, Justin Nielsen, Lori Sankaran, Deepika Agrawal, Vikash Chandrasekharan, Praveen Rawat, Munmun Berkelhamer, Sara K. Lakshminrusimha, Satyan |
author_facet | Nair, Jayasree Davidson, Lauren Gugino, Sylvia Koenigsknecht, Carmon Helman, Justin Nielsen, Lori Sankaran, Deepika Agrawal, Vikash Chandrasekharan, Praveen Rawat, Munmun Berkelhamer, Sara K. Lakshminrusimha, Satyan |
author_sort | Nair, Jayasree |
collection | PubMed |
description | The optimal timing of cord clamping in asphyxia is not known. Our aims were to determine the effect of ventilation (sustained inflation–SI vs. positive pressure ventilation–V) with early (ECC) or delayed cord clamping (DCC) in asphyxiated near-term lambs. We hypothesized that SI with DCC improves gas exchange and hemodynamics in near-term lambs with asphyxial bradycardia. A total of 28 lambs were asphyxiated to a mean blood pressure of 22 mmHg. Lambs were randomized based on the timing of cord clamping (ECC—immediate, DCC—60 s) and mode of initial ventilation into five groups: ECC + V, ECC + SI, DCC, DCC + V and DCC + SI. The magnitude of placental transfusion was assessed using biotinylated RBC. Though an asphyxial bradycardia model, 2–3 lambs in each group were arrested. There was no difference in primary outcomes, the time to reach baseline carotid blood flow (CBF), HR ≥ 100 bpm or MBP ≥ 40 mmHg. SI reduced pulmonary (PBF) and umbilical venous (UV) blood flow without affecting CBF or umbilical arterial blood flow. A significant reduction in PBF with SI persisted for a few minutes after birth. In our model of perinatal asphyxia, an initial SI breath increased airway pressure, and reduced PBF and UV return with an intact cord. Further clinical studies evaluating the timing of cord clamping and ventilation strategy in asphyxiated infants are warranted. |
format | Online Article Text |
id | pubmed-8145980 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-81459802021-05-26 Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord Nair, Jayasree Davidson, Lauren Gugino, Sylvia Koenigsknecht, Carmon Helman, Justin Nielsen, Lori Sankaran, Deepika Agrawal, Vikash Chandrasekharan, Praveen Rawat, Munmun Berkelhamer, Sara K. Lakshminrusimha, Satyan Children (Basel) Article The optimal timing of cord clamping in asphyxia is not known. Our aims were to determine the effect of ventilation (sustained inflation–SI vs. positive pressure ventilation–V) with early (ECC) or delayed cord clamping (DCC) in asphyxiated near-term lambs. We hypothesized that SI with DCC improves gas exchange and hemodynamics in near-term lambs with asphyxial bradycardia. A total of 28 lambs were asphyxiated to a mean blood pressure of 22 mmHg. Lambs were randomized based on the timing of cord clamping (ECC—immediate, DCC—60 s) and mode of initial ventilation into five groups: ECC + V, ECC + SI, DCC, DCC + V and DCC + SI. The magnitude of placental transfusion was assessed using biotinylated RBC. Though an asphyxial bradycardia model, 2–3 lambs in each group were arrested. There was no difference in primary outcomes, the time to reach baseline carotid blood flow (CBF), HR ≥ 100 bpm or MBP ≥ 40 mmHg. SI reduced pulmonary (PBF) and umbilical venous (UV) blood flow without affecting CBF or umbilical arterial blood flow. A significant reduction in PBF with SI persisted for a few minutes after birth. In our model of perinatal asphyxia, an initial SI breath increased airway pressure, and reduced PBF and UV return with an intact cord. Further clinical studies evaluating the timing of cord clamping and ventilation strategy in asphyxiated infants are warranted. MDPI 2021-04-29 /pmc/articles/PMC8145980/ /pubmed/33946658 http://dx.doi.org/10.3390/children8050353 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Nair, Jayasree Davidson, Lauren Gugino, Sylvia Koenigsknecht, Carmon Helman, Justin Nielsen, Lori Sankaran, Deepika Agrawal, Vikash Chandrasekharan, Praveen Rawat, Munmun Berkelhamer, Sara K. Lakshminrusimha, Satyan Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord |
title | Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord |
title_full | Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord |
title_fullStr | Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord |
title_full_unstemmed | Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord |
title_short | Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord |
title_sort | sustained inflation reduces pulmonary blood flow during resuscitation with an intact cord |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8145980/ https://www.ncbi.nlm.nih.gov/pubmed/33946658 http://dx.doi.org/10.3390/children8050353 |
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