Is air trapping important in the maintenance of the functional residual capacity in the hours after birth?

Milner, Anthony; Saunders, Richard; Hopkin, I E

doi:10.1016/0378-3782(78)90001-4

Cited by 24 publications

(11 citation statements)

References 11 publications

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“…The crying pattern has not been described in earlier reports (7,30,31). All other interrupted expiratory patterns shown in this study were described previously and were considered strategies to defend lung volume (11,12,14,15,(32)(33)(34)(35). We were not able to show a difference in breathing between the groups, except that preterm infants use the expiratory breath hold more often than term infants.…”

Section: Discussionmentioning

confidence: 47%

“…Diaphragmatic postinspiratory activity slows the rate of lung deflation by counteracting its passive recoil (12,14,15,32,33). Closure or narrowing of the larynx increases the resistance to expiration (11,15,34,35). During braked expiration, the closed or narrowed glottis, with increased intrapulmonary pressure from abdominal muscle contraction, causes the airway pressure to be maintained above atmospheric.…”

Section: Discussionmentioning

confidence: 99%

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Breathing Patterns in Preterm and Term Infants Immediately After Birth

et al. 2009

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There is limited data describing how preterm and term infants breathe spontaneously immediately after birth. We studied spontaneously breathing infants Ն29 wk immediately after birth. Airway flow and tidal volume were measured for 90 s using a hot wire anemometer attached to a facemask. Twelve preterm and 13 term infants had recordings suitable for analysis. The median (interquartile range) proportion of expiratory braking was very high in both groups (preterm 90 ͓74 -99͔ vs. term 87 ͓74 -94͔%; NS). Crying pattern was the predominant breathing pattern for both groups (62 ͓36 -77͔% vs. 64 ͓46 -79͔%; NS). Preterm infants showed a higher incidence of expiratory hold pattern (9 ͓4 -17͔% vs. 2 ͓0 -6͔%; p ϭ 0.02). Both groups had large tidal volumes (6.7 ͓3.9͔ vs. 6.5 ͓4.1͔ mL/kg), high peak inspiratory flows (5.7 ͓3.8͔ vs. 8.0 ͓5͔ L/min), lower peak expiratory flow (3.6 ͓2.4͔ vs. 4.8 ͓3.2͔ L/min), short inspiration time (0.31 ͓0.13͔ vs. 0.32 ͓0.16͔ s) and long expiration time (0.93 ͓0.64͔ vs. 1.14 ͓0.86͔ s). Directly after birth, both preterm and term infants frequently brake their expiration, mostly by crying. Preterm infants use significantly more expiratory breath holds to defend their lung volume. (Pediatr Res 65: 352-356, 2009)

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Section: Discussionmentioning

confidence: 47%

Section: Discussionmentioning

confidence: 99%

Breathing Patterns in Preterm and Term Infants Immediately After Birth

et al. 2009

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“…The normal functional residual capacity of ϳ30 ml/kg body wt is usually attained within 2-3 h of birth (123,397). Following the replacement of liquid with air, surface tension at the air-liquid interface is created.…”

Section: Surface Tension-air Liquid Interfacementioning

confidence: 99%

Regulation of the Pulmonary Circulation in the Fetus and Newborn

Gao

Raj

2010

Physiological Reviews

298

267

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During the development of the pulmonary vasculature in the fetus, many structural and functional changes occur to prepare the lung for the transition to air breathing. The development of the pulmonary circulation is genetically controlled by an array of mitogenic factors in a temporo-spatial order. With advancing gestation, pulmonary vessels acquire increased vasoreactivity. The fetal pulmonary vasculature is exposed to a low oxygen tension environment that promotes high intrinsic myogenic tone and high vasocontractility. At birth, a dramatic reduction in pulmonary arterial pressure and resistance occurs with an increase in oxygen tension and blood flow. The striking hemodynamic differences in the pulmonary circulation of the fetus and newborn are regulated by various factors and vasoactive agents. Among them, nitric oxide, endothelin-1, and prostaglandin I(2) are mainly derived from endothelial cells and exert their effects via cGMP, cAMP, and Rho kinase signaling pathways. Alterations in these signaling pathways may lead to vascular remodeling, high vasocontractility, and persistent pulmonary hypertension of the newborn.

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“…Term and preterm infants begin to breathe after delivery with deep inspirations and braking of expirations (3-7). Closure of the larynx during expiration may help the newborn to maintain FRC (6,8).Clinical and laboratory observations have shown that the application of continuous positive airway pressure (CPAP) helps to establish a gaseous FRC and improve gas exchange (9 -11). In a preterm animal model, the application of SIs of 10 to 20 s duration did further enhance movement of amniotic fluid into the distal airways resulting in an increased FRC and more uniform lung aeration than CPAP alone (10,12).…”

mentioning

confidence: 99%

“…Term and preterm infants begin to breathe after delivery with deep inspirations and braking of expirations (3)(4)(5)(6)(7). Closure of the larynx during expiration may help the newborn to maintain FRC (6,8).…”

mentioning

confidence: 99%

Cerebral Oxygenation in Very Low Birth Weight Infants Supported With Sustained Lung Inflations After Birth

et al. 2011

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Sustained lung inflations (SIs) immediately after birth might decrease the need for subsequent mechanical ventilation in preterm infants. However, effects of SIs on oxygenation and hemodynamics are undetermined. Our aim was to study immediate effects of SIs on heart rate, arterial oxygen saturation, and cerebral tissue oxygen saturation in preterm infants supported with SIs after birth for lung recruitment. Heart rate, arterial oxygen saturation, and cerebral tissue oxygen saturation using near infrared spectroscopy was measured in 24 preterm infants of 28.0 (26.6 -29.3) wk GA [median (interquartile range)] during resuscitation using up to three SIs of 20, 25, and 30 cm H 2 O of 15 s duration each followed by nasal continuous positive airway pressure (CPAP) as first line approach for respiratory support. During positioning and suctioning immediately after delivery infants became progressively hypoxemic and bradycardic before respiratory support was initiated. In 18 infants (75%), more than one SI were applied. During the last SIs, there was a rapid increase in the infants' heart rate and an increase in cerebral tissue oxygen saturation. Arterial saturation increased with slight delay. In conclusion, effective last sustained inflations increase heart rate and cerebral tissue oxygen saturation to be followed by an increase in arterial saturation. (Pediatr Res 70: 176-180, 2011) R eplacement of amniotic fluid by air to establish a gaseous functional residual capacity (FRC) is essential for successful transition after birth (1,2). Term and preterm infants begin to breathe after delivery with deep inspirations and braking of expirations (3-7). Closure of the larynx during expiration may help the newborn to maintain FRC (6,8).Clinical and laboratory observations have shown that the application of continuous positive airway pressure (CPAP) helps to establish a gaseous FRC and improve gas exchange (9 -11). In a preterm animal model, the application of SIs of 10 to 20 s duration did further enhance movement of amniotic fluid into the distal airways resulting in an increased FRC and more uniform lung aeration than CPAP alone (10,12).Clinical studies suggest that the use of SIs in preterm infants may help to reduce the need for intubation and mechanical ventilation without adverse effects (13,14). A lower rate of bronchopulmonary dysplasia (BPD) was reported in one study when SIs followed by nasal CPAP was compared with bag and mask ventilation (13). However, these trials have limited power to prove safety of SIs.Possible sequelae of SIs include overdistension of the lung and compromise of hemodynamics as a result of the impaired systemic venous return and decreased pulmonary blood flow caused by the increase in intrathoracic pressure during the procedure (15-18). Cerebral blood flow may be impaired resulting in brain damage in the preterm infant (19 -21). Impaired cerebral venous flow may predispose to intraventricular hemorrhage (IVH) (22) or periventricular hemorrhagic infarction (23,24).Near-infrared spectros...

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Is air trapping important in the maintenance of the functional residual capacity in the hours after birth?

Cited by 24 publications

References 11 publications

Breathing Patterns in Preterm and Term Infants Immediately After Birth

Breathing Patterns in Preterm and Term Infants Immediately After Birth

Regulation of the Pulmonary Circulation in the Fetus and Newborn

Cerebral Oxygenation in Very Low Birth Weight Infants Supported With Sustained Lung Inflations After Birth

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