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Tytuł:
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Physiologically based cord clamping improves cardiopulmonary haemodynamics in lambs with a diaphragmatic hernia.
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Autorzy:
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Kashyap AJ; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Hodges RJ; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.; Monash Women's Service, Monash Health, Melbourne, Victoria, Australia.
Thio M; Newborn Research, Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia.; Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Rodgers KA; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Amberg BJ; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
McGillick EV; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Hooper SB; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.; The Ritchie Centre, The Hudson Institute for Medical Research, Clayton, Victoria, Australia.
Crossley KJ; The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
DeKoninck PLJ; The Ritchie Centre, The Hudson Institute for Medical Research, Clayton, Victoria, Australia.; Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands.
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Źródło:
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Archives of disease in childhood. Fetal and neonatal edition [Arch Dis Child Fetal Neonatal Ed] 2020 Jan; Vol. 105 (1), pp. 18-25. Date of Electronic Publication: 2019 May 23.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Original Publication: London : British Medical Association,
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MeSH Terms:
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Cardiac Output*
Constriction*
Hernias, Diaphragmatic, Congenital*
Positive-Pressure Respiration*
Pulmonary Circulation*
Umbilical Cord*
Animals ; Animals, Newborn ; Asphyxia Neonatorum/prevention & control ; Brain/metabolism ; Disease Models, Animal ; Oxygen/metabolism ; Sheep ; Tidal Volume ; Vascular Resistance
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Contributed Indexing:
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Keywords: congenital diaphragmatic hernia; neonatal transition; perinatal care; pulmonary hypertension
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Substance Nomenclature:
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S88TT14065 (Oxygen)
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Entry Date(s):
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Date Created: 20190525 Date Completed: 20191223 Latest Revision: 20191223
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Update Code:
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20240104
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DOI:
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10.1136/archdischild-2019-316906
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PMID:
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31123056
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Objective: Lung hypoplasia associated with congenital diaphragmatic hernia (CDH) results in respiratory insufficiency and pulmonary hypertension after birth. We have investigated whether aerating the lung before removing placental support (physiologically based cord clamping (PBCC)), improves the cardiopulmonary transition in lambs with a CDH.
Methods: At ≈138 days of gestational age, 17 lambs with surgically induced left-sided diaphragmatic hernia (≈d80) were delivered via caesarean section. The umbilical cord was clamped either immediately prior to ventilation onset (immediate cord clamping (ICC); n=6) or after achieving a target tidal volume of 4 mL/kg, with a maximum delay of 10 min (PBCC; n=11). Lambs were ventilated for 120 min and physiological changes recorded.
Results: Pulmonary blood flow (PBF) increased following ventilation onset in both groups, but was 19-fold greater in PBCC compared with ICC lambs at cord clamping (19±6.3 vs 1.0±0.5 mL/min/kg, p<0.001). Cerebral tissue oxygenation was higher in PBCC than ICC lambs during the first 10 min after cord clamping (59%±4% vs 30%±5%, p<0.001). PBF was threefold higher (23±4 vs 8±2 mL/min/kg, p=0.01) and pulmonary vascular resistance (PVR) was threefold lower (0.6±0.1 vs 2.2±0.6 mm Hg/(mL/min), p<0.001) in PBCC lambs compared with ICC lambs at 120 min after ventilation onset.
Conclusions: Compared with ICC, PBCC prevented the severe asphyxia immediately after birth and resulted in a higher PBF due to a lower PVR, which persisted for at least 120 min after birth in CDH lambs.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)
