Ventilation prior to umbilical cord clamping improves cardiovascular stability and oxygenation in preterm lambs after exposure to intrauterine inflammation

Alessandra Lio, Claudia Aurilia, Valerie Zahra, Timothy J. Moss, Domenic A. LaRosa, Stuart B. Hooper, Andrew W. Gill, Martin Kluckow, Ilias Nitsos, Giovanni Vento, Graeme R. Polglase

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Delaying umbilical cord clamping until after aeration of the lung (physiological-based cord clamping; PBCC) maintains cardiac output and oxygenation in preterm lambs at birth, however, its efficacy after intrauterine inflammation is not known. Given the high incidence of chorioamnionitis in preterm infants, we investigated whether PBCC conferred any benefits compared to immediate cord clamping (ICC) in preterm lambs exposed antenatally to 7 days of intrauterine inflammation. Methods: Ultrasound guided intraamniotic injection of 20 mg Lipopolysaccharide (from E. coli:055:B5) was administered to pregnant ewes at 0.8 gestation. Seven days later, ewes were anesthetized, preterm fetuses exteriorised via cesarean section, and instrumented for continuous measurement of pulmonary, systemic and cerebral pressures and flows, and systemic, and cerebral oxygenation. Lambs were then randomized to either PBCC, whereupon ventilation was initiated and maintained for 3 min prior to umbilical cord clamping, or ICC where the umbilical cord was cut and ventilation initiated 30 s later. Ventilation was maintained for 30 min. Results: ICC caused a rapid fall in systemic (by 25%) and cerebral (by 11%) oxygen saturation in ICC lambs, concurrent with a rapid increase in carotid arterial pressure and heart rate. The overshoot in carotid arterial pressure was sustained in ICC lambs for the first 20 min of the study. PBCC maintained cardiac output and prevented the fall in cerebral oxygen delivery at birth. PBCC lambs had lower respiratory compliance and higher respiratory requirements throughout the study. Conclusion: PBCC mitigated the adverse effects of ICC on oxygenation and cardiac output, and therefore could be more beneficial in preterm babies exposed to antenatal inflammation as it maintains cardiac output and oxygen delivery. The increased respiratory requirements require further investigation in this sub-group of preterm infants.

Original languageEnglish
Article number286
Number of pages9
JournalFrontiers in Pediatrics
Volume6
DOIs
Publication statusPublished - 1 Jan 2018

Keywords

  • Chorioamnionitis
  • Delayed cord clamping
  • Physiological-based cord clamping
  • Placental transfusion
  • Premature birth

Cite this

Lio, Alessandra ; Aurilia, Claudia ; Zahra, Valerie ; Moss, Timothy J. ; LaRosa, Domenic A. ; Hooper, Stuart B. ; Gill, Andrew W. ; Kluckow, Martin ; Nitsos, Ilias ; Vento, Giovanni ; Polglase, Graeme R. / Ventilation prior to umbilical cord clamping improves cardiovascular stability and oxygenation in preterm lambs after exposure to intrauterine inflammation. In: Frontiers in Pediatrics. 2018 ; Vol. 6.
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title = "Ventilation prior to umbilical cord clamping improves cardiovascular stability and oxygenation in preterm lambs after exposure to intrauterine inflammation",
abstract = "Background: Delaying umbilical cord clamping until after aeration of the lung (physiological-based cord clamping; PBCC) maintains cardiac output and oxygenation in preterm lambs at birth, however, its efficacy after intrauterine inflammation is not known. Given the high incidence of chorioamnionitis in preterm infants, we investigated whether PBCC conferred any benefits compared to immediate cord clamping (ICC) in preterm lambs exposed antenatally to 7 days of intrauterine inflammation. Methods: Ultrasound guided intraamniotic injection of 20 mg Lipopolysaccharide (from E. coli:055:B5) was administered to pregnant ewes at 0.8 gestation. Seven days later, ewes were anesthetized, preterm fetuses exteriorised via cesarean section, and instrumented for continuous measurement of pulmonary, systemic and cerebral pressures and flows, and systemic, and cerebral oxygenation. Lambs were then randomized to either PBCC, whereupon ventilation was initiated and maintained for 3 min prior to umbilical cord clamping, or ICC where the umbilical cord was cut and ventilation initiated 30 s later. Ventilation was maintained for 30 min. Results: ICC caused a rapid fall in systemic (by 25{\%}) and cerebral (by 11{\%}) oxygen saturation in ICC lambs, concurrent with a rapid increase in carotid arterial pressure and heart rate. The overshoot in carotid arterial pressure was sustained in ICC lambs for the first 20 min of the study. PBCC maintained cardiac output and prevented the fall in cerebral oxygen delivery at birth. PBCC lambs had lower respiratory compliance and higher respiratory requirements throughout the study. Conclusion: PBCC mitigated the adverse effects of ICC on oxygenation and cardiac output, and therefore could be more beneficial in preterm babies exposed to antenatal inflammation as it maintains cardiac output and oxygen delivery. The increased respiratory requirements require further investigation in this sub-group of preterm infants.",
keywords = "Chorioamnionitis, Delayed cord clamping, Physiological-based cord clamping, Placental transfusion, Premature birth",
author = "Alessandra Lio and Claudia Aurilia and Valerie Zahra and Moss, {Timothy J.} and LaRosa, {Domenic A.} and Hooper, {Stuart B.} and Gill, {Andrew W.} and Martin Kluckow and Ilias Nitsos and Giovanni Vento and Polglase, {Graeme R.}",
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Ventilation prior to umbilical cord clamping improves cardiovascular stability and oxygenation in preterm lambs after exposure to intrauterine inflammation. / Lio, Alessandra; Aurilia, Claudia; Zahra, Valerie; Moss, Timothy J.; LaRosa, Domenic A.; Hooper, Stuart B.; Gill, Andrew W.; Kluckow, Martin; Nitsos, Ilias; Vento, Giovanni; Polglase, Graeme R.

In: Frontiers in Pediatrics, Vol. 6, 286, 01.01.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Ventilation prior to umbilical cord clamping improves cardiovascular stability and oxygenation in preterm lambs after exposure to intrauterine inflammation

AU - Lio, Alessandra

AU - Aurilia, Claudia

AU - Zahra, Valerie

AU - Moss, Timothy J.

AU - LaRosa, Domenic A.

AU - Hooper, Stuart B.

AU - Gill, Andrew W.

AU - Kluckow, Martin

AU - Nitsos, Ilias

AU - Vento, Giovanni

AU - Polglase, Graeme R.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Delaying umbilical cord clamping until after aeration of the lung (physiological-based cord clamping; PBCC) maintains cardiac output and oxygenation in preterm lambs at birth, however, its efficacy after intrauterine inflammation is not known. Given the high incidence of chorioamnionitis in preterm infants, we investigated whether PBCC conferred any benefits compared to immediate cord clamping (ICC) in preterm lambs exposed antenatally to 7 days of intrauterine inflammation. Methods: Ultrasound guided intraamniotic injection of 20 mg Lipopolysaccharide (from E. coli:055:B5) was administered to pregnant ewes at 0.8 gestation. Seven days later, ewes were anesthetized, preterm fetuses exteriorised via cesarean section, and instrumented for continuous measurement of pulmonary, systemic and cerebral pressures and flows, and systemic, and cerebral oxygenation. Lambs were then randomized to either PBCC, whereupon ventilation was initiated and maintained for 3 min prior to umbilical cord clamping, or ICC where the umbilical cord was cut and ventilation initiated 30 s later. Ventilation was maintained for 30 min. Results: ICC caused a rapid fall in systemic (by 25%) and cerebral (by 11%) oxygen saturation in ICC lambs, concurrent with a rapid increase in carotid arterial pressure and heart rate. The overshoot in carotid arterial pressure was sustained in ICC lambs for the first 20 min of the study. PBCC maintained cardiac output and prevented the fall in cerebral oxygen delivery at birth. PBCC lambs had lower respiratory compliance and higher respiratory requirements throughout the study. Conclusion: PBCC mitigated the adverse effects of ICC on oxygenation and cardiac output, and therefore could be more beneficial in preterm babies exposed to antenatal inflammation as it maintains cardiac output and oxygen delivery. The increased respiratory requirements require further investigation in this sub-group of preterm infants.

AB - Background: Delaying umbilical cord clamping until after aeration of the lung (physiological-based cord clamping; PBCC) maintains cardiac output and oxygenation in preterm lambs at birth, however, its efficacy after intrauterine inflammation is not known. Given the high incidence of chorioamnionitis in preterm infants, we investigated whether PBCC conferred any benefits compared to immediate cord clamping (ICC) in preterm lambs exposed antenatally to 7 days of intrauterine inflammation. Methods: Ultrasound guided intraamniotic injection of 20 mg Lipopolysaccharide (from E. coli:055:B5) was administered to pregnant ewes at 0.8 gestation. Seven days later, ewes were anesthetized, preterm fetuses exteriorised via cesarean section, and instrumented for continuous measurement of pulmonary, systemic and cerebral pressures and flows, and systemic, and cerebral oxygenation. Lambs were then randomized to either PBCC, whereupon ventilation was initiated and maintained for 3 min prior to umbilical cord clamping, or ICC where the umbilical cord was cut and ventilation initiated 30 s later. Ventilation was maintained for 30 min. Results: ICC caused a rapid fall in systemic (by 25%) and cerebral (by 11%) oxygen saturation in ICC lambs, concurrent with a rapid increase in carotid arterial pressure and heart rate. The overshoot in carotid arterial pressure was sustained in ICC lambs for the first 20 min of the study. PBCC maintained cardiac output and prevented the fall in cerebral oxygen delivery at birth. PBCC lambs had lower respiratory compliance and higher respiratory requirements throughout the study. Conclusion: PBCC mitigated the adverse effects of ICC on oxygenation and cardiac output, and therefore could be more beneficial in preterm babies exposed to antenatal inflammation as it maintains cardiac output and oxygen delivery. The increased respiratory requirements require further investigation in this sub-group of preterm infants.

KW - Chorioamnionitis

KW - Delayed cord clamping

KW - Physiological-based cord clamping

KW - Placental transfusion

KW - Premature birth

UR - http://www.scopus.com/inward/record.url?scp=85056388474&partnerID=8YFLogxK

U2 - 10.3389/fped.2018.00286

DO - 10.3389/fped.2018.00286

M3 - Article

VL - 6

JO - Frontiers in Pediatrics

JF - Frontiers in Pediatrics

SN - 2296-2360

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