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Volume 8
Issue 4
10.3390/children8040307
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Article

Resuscitation with an Intact Cord Enhances Pulmonary Vasodilation and Ventilation with Reduction in Systemic Oxygen Exposure and Oxygen Load in an Asphyxiated Preterm Ovine Model

by
Praveen Chandrasekharan
1,*,
Sylvia Gugino
1,
Justin Helman
1,
Carmon Koenigsknecht
1,
Lori Nielsen
1,
Nicole Bradley
1,
Jayasree Nair
1,
Vikash Agrawal
2,
Mausma Bawa
1,
Andreina Mari
1,
Munmun Rawat
1 and
Satyan Lakshminrusimha
3
1
Department of Pediatrics, Jacobs School of Medicine & Biomedical Sciences, University at Buffalo, Buffalo, NY 14260, USA
2
Department of Pediatrics, Loma Linda University, Loma Linda, CA 92350, USA
3
Department of Pediatrics, Division of Neonatology, University of California Davis School of Medicine, Sacramento, CA 95817, USA
*
Author to whom correspondence should be addressed.
Children 2021, 8(4), 307; https://doi.org/10.3390/children8040307
Submission received: 1 April 2021 / Revised: 13 April 2021 / Accepted: 15 April 2021 / Published: 17 April 2021
(This article belongs to the Special Issue Neonatal Resuscitation with Placental Circulation Intact)
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Abstract

(1) Background: Optimal initial oxygen (O2) concentration in preterm neonates is controversial. Our objectives were to compare the effect of delayed cord clamping with ventilation (DCCV) to early cord clamping followed by ventilation (ECCV) on O2 exposure, gas exchange, and hemodynamics in an asphyxiated preterm ovine model. (2) Methods: Asphyxiated preterm lambs (127–128 d) with heart rate <90 bpm were randomly assigned to DCCV or ECCV. In DCCV, positive pressure ventilation (PPV) was initiated with 30–60% O2 and titrated based on preductal saturations (SpO2) with an intact cord for 5 min, followed by clamping. In ECCV, the cord was clamped, and PPV was initiated. (3) Results: Fifteen asphyxiated preterm lambs were randomized to DCCV (N = 7) or ECCV (N = 8). The inspired O2 (40 ± 20% vs. 60 ± 20%, p < 0.05) and oxygen load (520 (IQR 414–530) vs. 775 (IQR 623–868), p-0.03) in the DCCV group were significantly lower than ECCV. Arterial oxygenation and carbon dioxide (PaCO2) levels were significantly lower and peak pulmonary blood flow was higher with DCCV. (4) Conclusion: In asphyxiated preterm lambs, resuscitation with an intact cord decreased O2 exposure load improved ventilation with an increase in peak pulmonary blood flow in the first 5 min.
Keywords: delayed cord clamping; oxygen exposure; preterm neonates delayed cord clamping; oxygen exposure; preterm neonates
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MDPI and ACS Style

Chandrasekharan, P.; Gugino, S.; Helman, J.; Koenigsknecht, C.; Nielsen, L.; Bradley, N.; Nair, J.; Agrawal, V.; Bawa, M.; Mari, A.; et al. Resuscitation with an Intact Cord Enhances Pulmonary Vasodilation and Ventilation with Reduction in Systemic Oxygen Exposure and Oxygen Load in an Asphyxiated Preterm Ovine Model. Children 2021, 8, 307. https://doi.org/10.3390/children8040307

AMA Style

Chandrasekharan P, Gugino S, Helman J, Koenigsknecht C, Nielsen L, Bradley N, Nair J, Agrawal V, Bawa M, Mari A, et al. Resuscitation with an Intact Cord Enhances Pulmonary Vasodilation and Ventilation with Reduction in Systemic Oxygen Exposure and Oxygen Load in an Asphyxiated Preterm Ovine Model. Children. 2021; 8(4):307. https://doi.org/10.3390/children8040307

Chicago/Turabian Style

Chandrasekharan, Praveen, Sylvia Gugino, Justin Helman, Carmon Koenigsknecht, Lori Nielsen, Nicole Bradley, Jayasree Nair, Vikash Agrawal, Mausma Bawa, Andreina Mari, and et al. 2021. "Resuscitation with an Intact Cord Enhances Pulmonary Vasodilation and Ventilation with Reduction in Systemic Oxygen Exposure and Oxygen Load in an Asphyxiated Preterm Ovine Model" Children 8, no. 4: 307. https://doi.org/10.3390/children8040307

APA Style

Chandrasekharan, P., Gugino, S., Helman, J., Koenigsknecht, C., Nielsen, L., Bradley, N., Nair, J., Agrawal, V., Bawa, M., Mari, A., Rawat, M., & Lakshminrusimha, S. (2021). Resuscitation with an Intact Cord Enhances Pulmonary Vasodilation and Ventilation with Reduction in Systemic Oxygen Exposure and Oxygen Load in an Asphyxiated Preterm Ovine Model. Children, 8(4), 307. https://doi.org/10.3390/children8040307

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