The primary objective of this study was to demonstrate shifts of plasma between vascular and extravascular spaces during the first 2\m=1/2\ hours of life. Such shifts in plasma volume have been postulated by Marks et al. in order to account for the significant rise in packed cell volume that they demonstrated within the first 2\m=1/2\hours of life.1 Plasma volume was measured by human serum-albumin-bound iodine131 (Risa, Abbott Laboratories). Since, to date, this agent has not been used for this purpose in newborn infants, a demonstration of its effectiveness was the second major objective. A third objective of this study was to relate the early changes occurring in the blood compartments to the pathogenesis of hyaline membrane disease. For this purpose, infants born by Cesarean section were compared with infants born by normal vaginal delivery.
Materials and MethodNine normal newborns and 9 elective Cesarean section infants were studied. The normal newborns were selected at random from the ward population of the Grace-New Haven Community Hospital. Elective Cesarean section infants were selected at random from the private and ward services of the Grace-New Haven Community Hospital. The only indication for Cesarean section in all cases was a previous Cesarean section.The cord was not touched. After one minute, the cord was clamped and cut. In the Cesarean section group, after the head and body were completely delivered, the baby was laid across the mother's legs for one minute. The cord was not touched. After one minute, the cord was clamped and cut. The patient was then transferred to a warm Armstrong incubator and evaluated by a member of the pediatrie house staff. If, after 5 minutes had passed, the baby was in good condition, it was accepted for the study.All Cesarean sections were performed under spinal or epidural anesthesia. Vaginal deliveries were performed under either local anesthesia or a combination of local anesthesia with nitrous oxide. In one case, cyclopropane was given. In many instances, in both the vaginal and Cesarean section groups, forceps were used to assist delivery.Using sterile technique, the umbilical cord was cut approximately 2 cm. from its base, and the umbilical vein was located and cannulated for 4 to 6 cm. with a sterile No. 5 French polyethylene infant feeding tube, which had been filled with heparinized saline. Via a 3-way stopcock, 8 cc. of blood were drawn into a heparinized syringe. Then, using a graduated standard 2 cm. syringe, approximately 0.04/iC of human serum-albuminbound iodine131 was injected into the umbilical catheter and flushed in with 4 cc. of blood from the heparinized syringe. The 2 cc. syringe was then rinsed 4 times with blood from the baby, and, finally, the entire system was rinsed and flushed into the baby with the remaining 4 cc. of heparin¬ ized blood. The polyethylene catheter was left in the umbilical vein. Five minutes after in¬ jection, mixing was assumed to be complete, and blood was removed for analysis. In order to flush 0 hr., 15 min. 2 hr., 15 m...