Abstract
Some previous studies reported a benefit to cardiopulmonary transition at birth when starting resuscitation maneuvers while the cord was still intact for a short period of time. However, the best timing for umbilical cord clamping in this condition is unknown. The aim of this study was to explore the duration of effective umbilico–placental circulation able to promote cardiorespiratory adaptation at birth during intact cord resuscitation. Umbilico–placental blood flow and vascular resistances were measured in an experimental neonatal lamb model. After a C-section delivery, the lambs were resuscitated ventilated for 1 h while the cord was intact. The maximum and mean umbilico–placental blood flow were respectively 230 ± 75 and 160 ± 12 mL·min−1 during the 1 h course of the experiment. However, umbilico–placental blood flow decreased and vascular resistance increased significantly 40 min after birth (p < 0.05). These results suggest that significant cardiorespiratory support can be provided by sustained placental circulation for at least 1 h during intact cord resuscitation.
Highlights
Immediate umbilical cord clamping (ICC) affects cardiopulmonary transition at birth.ICC results in an increase in peripheral systemic vascular resistance and in a decrease in the inferior vena cava flow
We further showed the safety, andbabies effectsuntil of intact cordwas resuscitation in newborn infants with congenital diafeasibility, safety, and effects of intact cord resuscitation in newborn infants with congenital phragmatic hernia [9]
These results suggest that significant cardiorespiratory support can be provided by sustained placental circulation for at least 1 h during intact cord resuscitation
Summary
ICC results in an increase in peripheral systemic vascular resistance and in a decrease in the inferior vena cava flow Both an increase in afterload and a decrease in preload result in a decrease in systemic blood flow [1]. In an experimental study in newborn lambs, we highlighted that placental gas exchange can be sustained after birth, provided special care is taken to prevent compression or kinking of the umbilical cord [7]. Both arterial and venous umbilical blood flow were measured during DCC using Doppler ultrasound in uncomplicated term vaginal deliveries [8]. Venous and arterial umbilical flow were measured for longer than previously described, and this was continued in about
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