The effect of breathing on ductus arteriosus blood flow directly after birth

Spontaneous breathing at birth influences ductus arteriosus (DA) flow. This study quantifies the effect of breathing on DA shunting directly after birth. In healthy term infants born by elective cesarean section, simultaneous measurements of DA shunting and tidal volumes during spontaneous breathing were performed at 2–5, 5–8, and 10–13 min after birth. Eight infants with a mean (SD) gestational age of 40 (1) weeks and 3216 (616) grams were studied. Inspiratory tidal volume was 5.8 (3.3–7.7), 5.7 (4.0–7.1), and 5.2 (4.3–6.1) mL/kg at 2–5, 5–8, and 10–13 min. The velocity time integral of left-to-right shunting significantly increased during inspiration when compared to expiration (8.4 (5.2) vs. 3.7 (2.3) cm, 8.9 (4.4) vs. 5.6 (3.4) cm, and 14.0 (6.7) vs. 8.4 (6.9) cm; all p < 0.0001) at 2–5, 5–8, and 10–13 min, respectively. In contrast, right-to-left shunting was not different between inspiration and expiration at 2–5 and 10–13 min (11.1 (2.4) vs. 11.1 (2.6) cm and 10.7 (2.3) vs. 10.6 (3.0) cm; p > 0.05), but there was a small increase at 5–8 min (12.1 (2.4) vs. 10.8 (2.9) cm; p = 0.001) during expiration. Conclusion: Directly after birth, ductal shunting is influenced by breathing effort, predominantly with an increase in left-to-right shunt due to inspiration.