Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord - PubMed (original) (raw)

doi: 10.3390/children8050353.

Lauren Davidson 1 2, Sylvia Gugino 1, Carmon Koenigsknecht 1, Justin Helman 1, Lori Nielsen 1, Deepika Sankaran 3, Vikash Agrawal 1 4, Praveen Chandrasekharan 1, Munmun Rawat 1, Sara K Berkelhamer 1 5, Satyan Lakshminrusimha 3

Affiliations

Sustained Inflation Reduces Pulmonary Blood Flow during Resuscitation with an Intact Cord

Jayasree Nair et al. Children (Basel). 2021.

Abstract

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.

Keywords: delayed cord clamping; perinatal asphyxia; placental transfusion; pulmonary blood flow; sustained inflation.

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Conflict of interest statement

The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1

Figure 1

Study groups based on the timing of cord clamping and type of ventilation. DCC: Delayed cord clamping, ECC: Early cord clamping, SI: Sustained inflation, PPV: Positive pressure ventilation.

Figure 2

Figure 2

Post resuscitation hemodynamics in the first 10 min after birth in the five study groups: (a) carotid blood flow, (b) pulmonary blood flow, (c) mean blood pressure and (d) systolic blood pressure in all five study groups, with dashed lines reflecting the SI groups. Data are represented as mean ± SD. Black circle: ECC + V (n = 5), pink square dashed: ECC + SI (n = 6), green triangle: DCC (n = 5), purple triangle: DCC + V (n = 5), purple diamond dashed: DCC + SI (n = 7).

Figure 3

Figure 3

Post resuscitation hemodynamics in the first 10 min after birth in ventilation groups—effect of sustained inflation (gray squares, N = 13) is compared to positive pressure ventilation (Black circles, N = 10): (a) carotid blood (CBF), (b) pulmonary blood flow (PBF), (c) mean blood pressure (MBP) and (d) systolic blood pressure (SBP). Data are represented as mean ± SD. * p < 0.01 by repeated measures ANOVA.

Figure 4

Figure 4

Post resuscitation hemodynamics in the first 10 min after birth based on the timing of cord clamping: (a) carotid blood flow, (b) pulmonary blood, (c) mean blood pressure and (d) systolic blood pressure. Data are represented as mean ± SD. * p < 0.05 repeated measures ANOVA. Black circles: ECC. Grey squares: DCC.

Figure 5

Figure 5

Summary: effects of (A) ECC + V—current practice, (B) DCC + V and (C) DCC + SI in our model of ovine asphyxia induced by cord occlusion.

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