From Fetus to Neonate: A Sensational Journey

Cavaliere, Terri A.

doi:10.1053/j.nainr.2016.03.004

Cited by 9 publications

(20 citation statements)

References 2 publications

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“…This eventually leads to the formation of the 4-chambered heart by gestational week 7 via heart looping and complex cellular interactions in utero [2]. Intrauterine fetal life is sustained in a secure, isolated, and hypoxemic environment that is dependent on the mother's placenta for nutrition, respiration, waste elimination, and metabolism [6]. To facilitate survival in the hypoxemic intrauterine environment, the fetus possesses structural, physiological, and functional cardiovascular adaptations that are fundamentally different from the neonate [3,4].…”

Section: Tan/lewandowskimentioning

confidence: 99%

“…To facilitate survival in the hypoxemic intrauterine environment, the fetus possesses structural, physiological, and functional cardiovascular adaptations that are fundamentally different from the neonate [3,4]. At birth, upon separation from the placental circulation, the neonatal cardiovascular system takes over responsibility of vital processes [6].…”

Section: Tan/lewandowskimentioning

confidence: 99%

“…The fetal cardiovascular system is adapted biochemically and structurally to ensure that the highly oxygenated blood is delivered preferentially from the placenta to the brain and the heart while being diverted away from the lungs. The combination of the following contributes to the maintenance of the fetal cardiovascular system: (i) biochemical factors, including vasoregulatory agents such as prostaglandins and endothelin-1 and (ii) anatomical adaptations, such as the presence of 4 shunts: the placenta, ductus venosus (DV), ductus arteriosus (DA), and foramen ovale (FO; Fig.3a) [6,[50][51][52].…”

Section: The Fetal Cardiovascular Systemmentioning

confidence: 99%

“…3a) [4]. The placenta is not only the source of nutrition but also an organ of waste elimination for the fetus; the supply of nutrients, as well as the exchange of oxygen and waste products, takes place in the intervillous space [6]. It is a low resistance vascular bed, which promotes the fetalto-maternal exchange of deoxygenated blood under low pressure [3,50].…”

Section: Fetal Structural Adaptations: the Four Shunts In Fetal Circumentioning

confidence: 99%

“…Following oxygenation in the intervillous spaces, relatively oxygenated fetal blood is carried by the umbilical vein to the liver [5,57]. The DV allows 50-60% of umbilical vein blood to bypass the hepatic circulation and enter the IVC, mixing with desaturated IVC blood [6,58]. The remainder of blood perfuses the liver, ultimately merging with desaturated blood from the lower part of the body via the IVC to enter the right atrium [6].…”

Section: Fetal Structural Adaptations: the Four Shunts In Fetal Circumentioning

confidence: 99%

See 4 more Smart Citations

The Transitional Heart: From Early Embryonic and Fetal Development to Neonatal Life

Tan

Lewandowski²

2019

Fetal Diagn Ther

173

123

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Formation of the human heart involves complex biological signals, interactions, specification of myocardial progenitor cells, and heart tube looping. To facilitate survival in the hypoxemic intrauterine environment, the fetus possesses structural, physiological, and functional cardiovascular adaptations that are fundamentally different from the neonate. At birth, upon separation from the placental circulation, the neonatal cardiovascular system takes over responsibility of vital processes for survival. The transition from the fetal to neonatal circulation is considered to be a period of intricate physiological, anatomical, and biochemical changes in the cardiovascular system. With a successful cardiopulmonary transition to the extrauterine environment, the fetal shunts are functionally modified or eliminated, enabling independent life. Investigations using medical imaging tools such as ultrasound and magnetic resonance imaging have helped to define normal and abnormal patterns of cardiac remodeling both in utero and ex utero. This has not only allowed for a better understanding of how congenital cardiac malforma-tions alter the hemodynamic transition to the extrauterine environment but also how other more common complications during pregnancy including intrauterine growth restriction, preeclampsia, and preterm delivery adversely affect offspring cardiac remodeling during this early transitional period. This review article describes key cardiac progenitors involved in embryonic heart development; the cellular, physiological, and anatomical changes during the transition from fetal to neonatal circulation; as well as the unique impact that different pregnancy complications have on cardiac remodeling.

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Section: Tan/lewandowskimentioning

confidence: 99%

Section: Tan/lewandowskimentioning

confidence: 99%

Section: The Fetal Cardiovascular Systemmentioning

confidence: 99%

Section: Fetal Structural Adaptations: the Four Shunts In Fetal Circumentioning

confidence: 99%

Section: Fetal Structural Adaptations: the Four Shunts In Fetal Circumentioning

confidence: 99%

See 3 more Smart Citations

The Transitional Heart: From Early Embryonic and Fetal Development to Neonatal Life

Tan

Lewandowski²

2019

Fetal Diagn Ther

173

123

View full text Add to dashboard Cite

show abstract

Molecular regulators of defective placental and cardiovascular development in fetal growth restriction

Umapathy,

Clark,

Sehgal

et al. 2024

Clinical Science

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Placental insufficiency is one of the major causes of fetal growth restriction (FGR), a significant pregnancy disorder in which the fetus fails to achieve its full growth potential in utero. As well as the acute consequences of being born too small, affected offspring are at increased risk of cardiovascular disease, diabetes and other chronic diseases in later life. The placenta and heart develop concurrently, therefore placental maldevelopment and function in FGR may have profound effect on the growth and differentiation of many organ systems, including the heart. Hence, understanding the key molecular players that are synergistically linked in the development of the placenta and heart is critical. This review highlights the key growth factors, angiogenic molecules and transcription factors that are common causes of defective placental and cardiovascular development.

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Impact of Acute and Chronic Hypoxia-Ischemia on the Transitional Circulation

et al. 2021

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The transition from intrauterine life to extrauterine existence encompasses significant cardiorespiratory adaptations. These include rapid lung aeration and increase in pulmonary blood flow (PBF). Perinatal asphyxia and fetal growth restriction can severely hamper this transition. Hypoxia is the common denominator in these 2 disease states, with the former characterized by acute insult and the latter by utero-placental insufficiency and a chronic hypoxemic state. Both may manifest as hemodynamic instability. In this review, we emphasize the role of physiologic-based cord clamping in supplementing PBF during transition. The critical role of lung aeration in initiating pulmonary gas exchange and increasing PBF is discussed. Physiologic studies in animal models have enabled greater understanding of the mechanisms and effects of various therapies on transitional circulation. With data from sheep models, we elaborate instrumentation for monitoring of cardiovascular and pulmonary physiology and discuss the combined effect of chest compressions and adrenaline in improving transition at birth. Lastly, physiologic adaptation influencing management in human neonatal cohorts with respect to cardiac and vascular impairments in hypoxic-ischemic encephalopathy and growth restriction is discussed. Impairments in right ventricular function and vascular mechanics hold the key to prognostication and understanding of therapeutic rationale in these critically ill cohorts. The right ventricle and pulmonary circulation seem to be especially affected and may be explored as therapeutic targets. The role of comprehensive assessments using targeted neonatal echocardiography as a longitudinal, reliable, and easily accessible tool, enabling precision medicine facilitating physiologically appropriate treatment choices, is discussed.

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From Fetus to Neonate: A Sensational Journey

Cited by 9 publications

References 2 publications

The Transitional Heart: From Early Embryonic and Fetal Development to Neonatal Life

The Transitional Heart: From Early Embryonic and Fetal Development to Neonatal Life

Molecular regulators of defective placental and cardiovascular development in fetal growth restriction

Impact of Acute and Chronic Hypoxia-Ischemia on the Transitional Circulation

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