Abstract
The neonatal transition involves physiological modifications as a consequence of the complexity of the perinatal period. Various strategies can be used to attain the same level of postnatal cerebral oxygenation, depending on the status of the infant at birth. We evaluated such strategies by recording 20 full-term newborns by near-infrared spectroscopy during the first 10 min of life. The acid–base status at birth revealed two clustered profiles of cerebral oxygenation dynamics. Lower pH and base excess and higher lactate levels were associated with more rapid attainment of the 95% maximal tissue oxygenation index value. These results suggest that metabolic mechanisms drive initial cerebral oxygenation dynamics during this critical period. These results confirm the capacity of newborns to develop multiple strategies to protect the brain.
Highlights
The neonatal transition involves physiological modifications as a consequence of the complexity of the perinatal period
We evaluated the individual hemodynamic strategies used to adapt to extrauterine life by analyzing the evolution of individual changes in cortical oxygenation parameters through Near-infrared spectroscopy (NIRS) measurements
Assessment of the dynamics of changes in brain oxygenation (i.e., tissue oxygenation index (TOI)) of healthy full-term neonates immediately postpartum highlights distinct cerebral hemodynamic strategies strongly linked to the initial values of pH, BE, and lactates
Summary
The neonatal transition involves physiological modifications as a consequence of the complexity of the perinatal period. Lower pH and base excess and higher lactate levels were associated with more rapid attainment of the 95% maximal tissue oxygenation index value These results suggest that metabolic mechanisms drive initial cerebral oxygenation dynamics during this critical period. Birth is a transitional at-risk situation in which the fetus passes from its intrauterine environment to become a neonate in its extrauterine environment This transition suggests the existence of well-coordinated complex adaptive physiological mechanisms modulated by the history of the pregnancy and possible vascular complications, as well as the labor and its management and the delivery procedures. Medical decisions concerning the neonate are clinically based on the Apgar score, developed in 1952 It consists of the evaluation of the color of the skin, the heart and respiration rate, and the tonus and reflexes, providing information about the efficiency of spontaneous breathing, which is essential for the immediate transition at 1 min. It is generally accepted that the Apgar score lacks o bjectivity[12]
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