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

Nair, Jayasree; Davidson, Lauren; Gugino, Sylvia F.; Koenigsknecht, Carmon; Helman, Justin; Nielsen, Lori; Sankaran, Deepika; Agrawal, Vikash; Chandrasekharan, Praveen; Rawat, Munmun; Berkelhamer, Sara; Lakshminrusimha, Satyanarayana

doi:10.3390/children8050353

Cited by 2 publications

(2 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There are reports of reduced blood flow to the heart with breathing movements. Newborn lamb experiments found that the umbilical venous flow was markedly reduced with each breath [72] and that a 30-s sustained inflation, even with delayed cord clamping, prevented the lamb's blood from flowing into the lung via the pulmonary artery and inferior vena cava [73]. A randomized control trial comparing sustained inflation with usual ventilation in human preterm infants was stopped because more early deaths occurred in the group of infants with sustained inflation [74].…”

Section: Notes On Breathingmentioning

confidence: 99%

Cardiac Asystole at Birth Re-Visited: Effects of Acute Hypovolemic Shock

2023

View full text Add to dashboard Cite

Births involving shoulder dystocia or tight nuchal cords can deteriorate rapidly. The fetus may have had a reassuring tracing just before birth yet may be born without any heartbeat (asystole). Since the publication of our first article on cardiac asystole with two cases, five similar cases have been published. We suggest that these infants shift blood to the placenta due to the tight squeeze of the birth canal during the second stage which compresses the cord. The squeeze transfers blood to the placenta via the firm-walled arteries but prevents blood returning to the infant via the soft-walled umbilical vein. These infants may then be born severely hypovolemic resulting in asystole secondary to the loss of blood. Immediate cord clamping (ICC) prevents the newborn’s access to this blood after birth. Even if the infant is resuscitated, loss of this large amount of blood volume may initiate an inflammatory response that can enhance neuropathologic processes including seizures, hypoxic–ischemic encephalopathy (HIE), and death. We present the role of the autonomic nervous system in the development of asystole and suggest an alternative algorithm to address the need to provide these infants intact cord resuscitation. Leaving the cord intact (allowing for return of the umbilical cord circulation) for several minutes after birth may allow most of the sequestered blood to return to the infant. Umbilical cord milking may return enough of the blood volume to restart the heart but there are likely reparative functions that are carried out by the placenta during the continued neonatal–placental circulation allowed by an intact cord.

show abstract

Section: Notes On Breathingmentioning

confidence: 99%

Cardiac Asystole at Birth Re-Visited: Effects of Acute Hypovolemic Shock

2023

View full text Add to dashboard Cite

show abstract

“…A recent newborn lamb experiment found that the umbilical venous flow was markedly reduced with each breath [42]. In another newborn lamb study, a 30-s sustained inflation, even with delayed cord clamping, prevented the lamb's blood from flowing into the lung via the pulmonary artery and inferior vena cava [43]. A randomized control trial comparing sustained inflation with usual ventilation in human preterm infants was stopped because more early deaths occurred in the infants with sustained inflation [44].…”

Section: Breathing After Birthmentioning

confidence: 99%

Making the Argument for Intact Cord Resuscitation: A Case Report and Discussion

et al. 2022

View full text Add to dashboard Cite

We use a case of intact cord resuscitation to argue for the beneficial effects of an enhanced blood volume from placental transfusion for newborns needing resuscitation. We propose that intact cord resuscitation supports the process of physiologic neonatal transition, especially for many of those newborns appearing moribund. Transfer of the residual blood in the placenta provides the neonate with valuable access to otherwise lost blood volume while changing from placental respiration to breathing air. Our hypothesis is that the enhanced blood flow from placental transfusion initiates mechanical and chemical forces that directly, and indirectly through the vagus nerve, cause vasodilatation in the lung. Pulmonary vascular resistance is thereby reduced and facilitates the important increased entry of blood into the alveolar capillaries before breathing commences. In the presented case, enhanced perfusion to the brain by way of an intact cord likely led to regained consciousness, initiation of breathing, and return of tone and reflexes minutes after birth. Paramount to our hypothesis is the importance of keeping the umbilical cord circulation intact during the first several minutes of life to accommodate physiologic neonatal transition for all newborns and especially for those most compromised infants.

show abstract

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

Cited by 2 publications

References 24 publications

Cardiac Asystole at Birth Re-Visited: Effects of Acute Hypovolemic Shock

Cardiac Asystole at Birth Re-Visited: Effects of Acute Hypovolemic Shock

Making the Argument for Intact Cord Resuscitation: A Case Report and Discussion

Contact Info

Product

Resources

About