Cardiovascular Alterations and Multiorgan Dysfunction After Birth Asphyxia

Polglase, Graeme R.; Ong, Tracey; Hillman, Noah H.

doi:10.1016/j.clp.2016.04.006

Cited by 62 publications

(46 citation statements)

References 91 publications

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“…In the fetus, the physiological response to asphyxia has been well described9 10 and involves both an increase and redistribution of cardiac output to increase perfusion and maintain oxygen delivery to vital organs, including the heart and brain 11. This is achieved via dilation of cerebral and coronary blood vessels and vasoconstriction of vascular beds in less vital organs (eg, skeletal muscle) including the lung 11 12.…”

Section: Introductionmentioning

confidence: 99%

Physiologically based cord clamping stabilises cardiac output and reduces cerebrovascular injury in asphyxiated near-term lambs

Polglase

Blank

Barton

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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Section: Introductionmentioning

confidence: 99%

Physiologically based cord clamping stabilises cardiac output and reduces cerebrovascular injury in asphyxiated near-term lambs

Polglase

Blank

Barton

et al. 2017

Arch Dis Child Fetal Neonatal Ed

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“…Systemic inflammation and multiple organ dysfunction in critically ill newborns are accompanied with circulatory failure. Redistribution of the circulation leads to underperfusion of the mucosa mainly in the gut [ 30 , 31 ]. Mucosal perfusion impairment and reperfusion injury following the stabilization of systemic circulation due to extracorporeal circulation therapy might cause the injury of the mucosal vessel endothelium.…”

Section: Discussionmentioning

confidence: 99%

Endothelial Microvesicles and Soluble Markers of Endothelial Injury in Critically Ill Newborns

Vítková

Pánek

Janec

et al. 2018

Mediators of Inflammation

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Neonatal systemic inflammatory response and multiple organ dysfunction syndrome are the main postnatal insults influencing mortality and morbidity. Critically ill newborns with high predicted mortality are supported by extracorporeal membrane oxygenation (ECMO). Biomarkers of inflammatory response and endothelial injury can be used for early diagnosis and treatment of critical neonatal situations. The aim of our study was to explore plasma proteins and endothelial microvesicles as markers of inflammation and endothelial activation in newborns on ECMO and to compare them with healthy neonates. Thirteen newborns on ECMO and 13 healthy newborns were included in the study. Plasma soluble biomarkers were measured using multiplex immunoassay based on Luminex® xMAP multianalyte profiling platform. The total microvesicle count and plasma level of surface antigen-specific microvesicles were determined by flow cytometry. The plasma concentration of cell-derived microvesicles was measured using annexin-V labeling, and the endothelial origin of microvesicles was determined using lineage-specific antigen labeling of endothelial cell/microvesicle markers (endoglin/CD105, PECAM1/CD31, VEGFR2/CD309, and MadCAM1). Inflammatory markers (procalcitonin, IL-1β, IL-6, and IL-22) were increased in the ECMO group (P < 0.01). The assessment of endothelial markers showed higher concentrations of endocan and angiopoietin-2 (P < 0.01) in the ECMO group while VEGF in the ECMO group was significantly lower (P < 0.01). In the ECMO group, the concentration of annexin-V-positive microvesicles (total microvesicles) and endothelial microvesicles expressing mucosal vascular addressin cell adhesion molecule 1 (MadCAM1) was increased (P = 0.05). In summary, we found increased concentrations of soluble inflammatory and endothelial markers in the plasma of critically ill newborns with multiple organ dysfunction. Increased plasma concentrations of microvesicles may reflect the activation or damage of blood cells and vasculature including endothelial cells. The measurement of cell membrane-derived microvesicles may be added to the panel of established inflammatory markers in order to increase the sensitivity and specificity of the diagnostic process in critically ill newborns.

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“…Irrespective of the severity, the initial physiological response to perinatal hypoxia is identical and extremely well described. Initially it involves bradycardia, apnea ( 42 , 43 ), a mild hypertension and an inhibition of body movements, along with a marked redistribution of cardiac output to increase blood flow and maintain oxygen supply to the heart and brain ( 44 , 45 ). Further, there is a well-established peripheral chemoreceptor mediated rebound hypertension which persists for 2–3 min ( 46 ).…”

Section: Discussionmentioning

confidence: 99%

Ventilation Prior to Umbilical Cord Clamping Improves Cardiovascular Stability and Oxygenation in Preterm Lambs After Exposure to Intrauterine Inflammation

et al. 2018

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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.

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Cardiovascular Alterations and Multiorgan Dysfunction After Birth Asphyxia

Cited by 62 publications

References 91 publications

Physiologically based cord clamping stabilises cardiac output and reduces cerebrovascular injury in asphyxiated near-term lambs

Physiologically based cord clamping stabilises cardiac output and reduces cerebrovascular injury in asphyxiated near-term lambs

Endothelial Microvesicles and Soluble Markers of Endothelial Injury in Critically Ill Newborns

Ventilation Prior to Umbilical Cord Clamping Improves Cardiovascular Stability and Oxygenation in Preterm Lambs After Exposure to Intrauterine Inflammation

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