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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
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.
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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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