Cardiovascular transition at birth: a physiological sequence

Stuart Brian Hooper, Arjan B Te Pas, Justin Lang, Jeroen J van Vonderen, Charles Christopher Roehr, Martin Kluckow, Andrew W Gill, Euan Morrison Wallace, Graeme Polglase

Research output: Contribution to journalArticleResearchpeer-review

101 Citations (Scopus)

Abstract

The transition to newborn life at birth involves major cardiovascular changes that are triggered by lung aeration. These include a large increase in pulmonary blood flow (PBF), which is required for pulmonary gas exchange and to replace umbilical venous return as the source of preload for the left heart. Clamping the umbilical cord before PBF increases reduces venous return and preload for the left heart and thereby reduces cardiac output. Thus, if ventilation onset is delayed following cord clamping, the infant is at risk of superimposing an ischemic insult, due to low cardiac output, on top of an asphyxic insult. Much debate has centered on the timing of cord clamping at birth, focusing mainly on the potential for a time-dependent placental to infant blood transfusion. This has prompted recommendations for delayed cord clamping for a set time after birth in infants not requiring resuscitation. However, recent evidence indicates that ventilation onset before cord clamping mitigates the adverse cardiovascular consequences caused by immediate cord clamping. This indicates that the timing of cord clamping should be based on the infant s physiology rather than an arbitrary period of time and that delayed cord clamping may be of greatest benefit to apneic infants.
Original languageEnglish
Pages (from-to)608 - 614
Number of pages7
JournalPediatric Research
Volume77
Issue number5
DOIs
Publication statusPublished - 2015

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