Alteration of the Infant's Thorax During Vaginal Delivery

Karlberg, P; Adams, Forrest H.; Geubelle, F; Wallgren, Göran

doi:10.3109/00016346209158099

Cited by 70 publications

(17 citation statements)

References 6 publications

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“…Karlberg et al [36] observed that relatively large subatmospheric pressures (20-40 cm H 2 O) were necessary before air started entering the lung, which was considered to be the ‘opening pressure' needed to overcome resistance and newly formed surface tension [37]. However, Saunders and Milner [25] could not confirm this and stated that the balloon in Karlberg's study was probably misplaced.…”

Section: Pulmonary Transitionmentioning

confidence: 79%

“…In 1962 Karlberg et al [1,36] used reverse plethysmography for lung volume measurements in human infants and reported that elastic recoil of the chest after expulsion from the birth canal caused air entering the lung [1,23,36]. The measurements were repeated later, but elastic recoil forcing air into the lung could not be confirmed [25].…”

Section: Pulmonary Transitionmentioning

confidence: 99%

“…Karlberg et al [36] and Saunders and Milner [25] have also measured transesophageal pressures using an esophageal balloon catheter. Karlberg et al [36] observed that relatively large subatmospheric pressures (20-40 cm H 2 O) were necessary before air started entering the lung, which was considered to be the ‘opening pressure' needed to overcome resistance and newly formed surface tension [37].…”

Section: Pulmonary Transitionmentioning

confidence: 99%

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Measuring Physiological Changes during the Transition to Life after Birth

Vonderen¹,

et al. 2014

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The transition to life after birth is characterized by major physiological changes in respiratory and hemodynamic function, which are predominantly initiated by breathing at birth and clamping of the umbilical cord. Lung aeration leads to the establishment of functional residual capacity, allowing pulmonary gas exchange to commence. This triggers a significant decrease in pulmonary vascular resistance, consequently increasing pulmonary blood flow and cardiac venous return. Clamping the umbilical cord also contributes to these hemodynamic changes by altering the cardiac preload and increasing peripheral systemic vascular resistance. The resulting changes in systemic and pulmonary circulation influence blood flow through both the oval foramen and ductus arteriosus. This eventually leads to closure of these structures and the separation of the pulmonary and systemic circulations. Most of our knowledge on human neonatal transition is based on human (fetal) data from the 1970s and extrapolation from animal studies. However, there is renewed interest in performing measurements directly at birth. By using less cumbersome techniques (and probably more accurate), our previous understanding of the physiological transition at birth is challenged, as well as the causes and consequences for when this transition fails to progress. This review will provide an overview of physiological measurements of the respiratory and hemodynamic transition at birth. Also, it will give a perspective on some of the upcoming technological advances in physiological measurements of neonatal transition in infants who are unable to make the transition without support.

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Section: Pulmonary Transitionmentioning

confidence: 79%

Section: Pulmonary Transitionmentioning

confidence: 99%

Section: Pulmonary Transitionmentioning

confidence: 99%

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Measuring Physiological Changes during the Transition to Life after Birth

Vonderen¹,

et al. 2014

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“…Provided there is low surface tension in the lung after introduction of air the resting position of the lungs should thus be the same wether they contain liquid or air (Strang, 1967). Lung liquid can be drain ed, probably mostly from the upper airways, in considerable amounts during the delivery process, particularly during vaginal vertex delivery (Karlberg et al, 1962) leading to a more or less extensive air filling of the upper air passages prior to the first breath (III; Lind et al, 1964). Although water in the alveolar spaces themselves may be ab sorbed mainly into the pulmonary circulation (Potter, 1953) there is, at least in the newborn lamb, also evidence for removal of lung liquid through lymphatic channels in the pulmonary interstitial tissue (Boston et al, 1965).…”

Section: Onset Of Respiration and Initial Respiratory Adjustmentmentioning

confidence: 99%

Lung Function and Acid‐base Balance in the Newborn Infant

Koch¹

1968

Acta Paediatrica

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Summary During gestation the placenta subserves the external respiration of the fetus as well as its metabolism. With the initiation of extrauterine life the placental circulation is eliminated and the fetus emerges from a watery environment into air. This implies the establishment of a new autonomic function, that of pulmonary respiration, which process is intimately linked to a profound readjustment of the circulation. The present series of investigations has been performed to elucidate certain of the processes involved in pulmonary gas exchange and to evaluate its efficiency compared to adult standards during the period of adjustment to extrauterine life. Though the most important and rapid changes in this adaptative process occur during the first seconds and minutes of extrauterine life they continue far beyond this period. Observations have therefore been extended until the end of the neonatal period defined as the first week of life; this has been considered particularly important as information as to the later period of this adjustment is scarce or lacking. Emphasis is laid on development of function. Because of the significant morbidity and mortality of the newborn infant in disorders of respiration all investigations throwing more light on the normal respiratory mechanisms and their alterations in disease have important practical implications by improving diagnostic possibilities and facilitating objective evaluation of therapeutic measures. A total of 172 healthy fullterm infants born after an uneventful pregnancy of normal length and uncomplicated vertex delivery are the subjects of the different studies. The size of the subjects to be studied and the lack of cooperation posed special methodological problems. Suitable procedures and methods permitting reproducible and valid measurements have been developed or adapted for the study of mechanics of breathing, functional residual capacity, pulmonary ventilation, diffusing capacity and gas exchange. Since capillary PO2 does not accurately reflect arterial PO2 a safe procedure permitting arterial blood sampling without disturbing steady state conditions had to be developed. The onset of respiration and initial aeration of the lungs is characterized by the generation of very high resistive forces, probably mainly due to high surface tension. Subsequently, lung compliance increases while lung resistance and inspiratory work decrease, the speed of these changes being highest in the beginning and slowing down subsequently. Within one hour after delivery, the functional residual capacity amounts to 40—80 ml and shows a relation to lung compliance similar to that later in life. Changes after 24 hours of life are insignificant. There is hypoxemia, CO2 retention and accumulation of fixed acids, i. e. respiratory and metabolic acidosis at birth. The respiratory component of acidosis is on the average abolished at 30 minutes and metabolic acidosis at 24 hours of life. PCO2 attains a minimum of about 33 mm Hg at 24 hours of life and increases slightly to 36 mm Hg at 7...

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“…Accordingly, the attention of obstetricians, pediatricians and anesthesiologists is directed towards finding methods of preventing meconium aspiration. As soon as the infant's thorax emerges from the vagina it expands due to its inherent elasticity and a first passive inspiration, and hence aspiration, occurs at this stage [27,28]. Because this is so, CARSON etal., [9] were able to show that suction and clearence of the upper airways as soon as the head is delivered while the thorax remains **An abstract of this article was delivered at the llth "Deutscher Kongreß für Perinatale Medizin", November [8][9][10][11]1983, Berlin compressed, led to a marked reduction in MAS morbidity.…”

Section: Introductionmentioning

confidence: 99%