Left ventricular output during postnatal circulatory adaptation in healthy infants born at full term.

Winberg, P.; Jansson, Maria; Marions, Lena; Lundell, Bo

doi:10.1136/adc.64.10_spec_no.1374

Cited by 41 publications

(24 citation statements)

References 23 publications

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“…It is possible that the increase in LVO was missed in the first minutes as the first measurements were conducted between 3 and 7 min. However, Noori et al [85] have shown that increasing SV is important for CO during the first minutes after birth as it is later during transition [52]. …”

Section: Measurements For Evaluating Transitionmentioning

confidence: 99%

“…After birth the increasing afterload will increase the likelihood of left-to-right shunt through the DA in the first days after birth. However, DA constriction will cause shunting through the DA to decrease [52]. Changes in SVR and the decrease in PVR resistance that occur during transition will cause blood pressure (BP) and flows in the pulmonary and systemic circulations to change.…”

Section: Hemodynamic Transitionmentioning

confidence: 99%

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Measuring Physiological Changes during the Transition to Life after Birth

Vonderen¹,

Roest

Siew

et al. 2014

Neonatology

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The transition to life after birth is characterized by major physiological changes in respiratory and hemodynamic function, which are predominantly initiated by breathing at birth and clamping of the umbilical cord. Lung aeration leads to the establishment of functional residual capacity, allowing pulmonary gas exchange to commence. This triggers a significant decrease in pulmonary vascular resistance, consequently increasing pulmonary blood flow and cardiac venous return. Clamping the umbilical cord also contributes to these hemodynamic changes by altering the cardiac preload and increasing peripheral systemic vascular resistance. The resulting changes in systemic and pulmonary circulation influence blood flow through both the oval foramen and ductus arteriosus. This eventually leads to closure of these structures and the separation of the pulmonary and systemic circulations. Most of our knowledge on human neonatal transition is based on human (fetal) data from the 1970s and extrapolation from animal studies. However, there is renewed interest in performing measurements directly at birth. By using less cumbersome techniques (and probably more accurate), our previous understanding of the physiological transition at birth is challenged, as well as the causes and consequences for when this transition fails to progress. This review will provide an overview of physiological measurements of the respiratory and hemodynamic transition at birth. Also, it will give a perspective on some of the upcoming technological advances in physiological measurements of neonatal transition in infants who are unable to make the transition without support.

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Section: Measurements For Evaluating Transitionmentioning

confidence: 99%

Section: Hemodynamic Transitionmentioning

confidence: 99%

Measuring Physiological Changes during the Transition to Life after Birth

Vonderen¹,

Roest

Siew

et al. 2014

Neonatology

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“…, 30 reflecting an adaption to the decreased demand on the left ventricle as the ductus arteriosus constricts and ductal left-to-right shunt decreases from 62 mL · min Ϫ1 · kg Ϫ1 at 1 to 2 hours of age to 14 mL · min Ϫ1 · kg Ϫ1 at 12 hours of age. 31,32 In human fetuses, the right heart dominance has been discussed controversially.…”

mentioning

confidence: 99%

“…During postnatal circulatory changes, 29 left cardiac output increases up to Ϸ240 mL · min Ϫ1 · kg Ϫ1 within the first 2 hours of birth because of increasing stroke volume. 30 Then left cardiac output falls to Ϸ190 mL · min Ϫ1 · kg…”

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confidence: 99%

Cardiac Output and Central Distribution of Blood Flow in the Human Fetus

2001

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Background-The objectives of this study were to establish reference ranges for left and right cardiac output and to investigate blood flow distribution through the foramen ovale, ductus arteriosus, and pulmonary bed in human fetuses. Methods and Results-A prospective study was performed in 222 normal fetuses from 13 to 41 weeks of gestation with high-resolution color Doppler ultrasound. Cardiac output and ductal flow were calculated by use of vessel diameter and the time-velocity integral. Pulmonary blood flow was expressed as the difference between right cardiac output and ductal flow. Foramen ovale flow was estimated as the difference between pulmonary flow and left cardiac output. Gestational age-specific reference ranges are given for left, right, and biventricular output and volume of ductal blood flow, showing an exponential increase with gestational age. Median ratio of right to left cardiac output was 1.42 and was not associated with gestational age. Right cardiac output was 59% and left cardiac output was 41% of biventricular cardiac output. Median biventricular cardiac output was estimated to be 425 mL · min Ϫ1 · kg Ϫ1 fetal weight. Ductal blood flow was 46%, estimated pulmonary flow was 11%, and estimated foramen ovale flow was 33% of biventricular output. Conclusions-The study establishes reference ranges for fetal cardiac output and offers insights into the central blood flow distribution in human fetuses from 13 weeks to term. There is a clear right heart dominance. The estimated ratio of pulmonary blood flow to cardiac output is higher than in fetal lamb studies. (Circulation. 2001;103:1662-1668.)

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“…In the present study, the left atrial to aortic root ratio and the inner diameter of the ductus arteriosus significantly increased in group 1 (mean age 1.8 hr after birth) compared with group 2 (mean age =13.0 hr after birth), thus the LV preload was suggested to be higher in group 1 than group 2. Several recent studies have shown that LV of human neonates have the ability to handle these increased preload imposed by PDA (Winberg et al 1989;Agata et al 1991), but the mechanism has not been clearly elucidated. As to the relationship between mVcfc and ESS, there was no significant difference between the 2 groups and the control in the slopes of the regression lines (Fig.…”

Section: Discussiqnmentioning

confidence: 99%

Left Ventricular Contractile State of Early Human Neonates with Patent Ductus Arteriosus.

Harada

Shiota

Tamura

et al. 1994

Tohoku J. Exp. Med.

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A. and TAKADA, G. Left Ventricular Contractile State of Early Human Neonates with Patent Ductus Arteriosus. Tohoku J. Exp. Med., 1994, 172 (2), 155-161 Using echocardiographic technique, we studied the left ventricular (LV) contractile state in 32 full-term infants within 24 hr after birth. They were divided into 2 groups based on the timing of the examinations; the group 1(n -17), < 3 hr after birth; the group 2 (n=15), > 3 and <24 hr after birth, and the additional examinations were performed on day 5. The patency of the ductus arteriosus and its internal diameter were determined by pulsed Doppler and two-dimensional echocardiography. The left atrial to aortic root ratio was obtained from M-mode echocardiography, and the LV contractile state was estimated by the relationship between heart rate-corrected velocity of circumferential fiber shortening (mVcfc) and end-systolic meridional wall stress (ESS). The ductus arteriosus was open in all cases of group 1 and in 83% of the cases of group 2, but the ductal diameter and the left atrial to aortic root ratio significantly decreased in group 2. The relationship between mVcfc and ESS showed no significant differences between 2 groups and the control. Afterload, represented as ESS, was significantly lower in group 1 than the control. We suggest that the low afterload condition helps the adequate LV contraction even under the increased preload through the left-to-right ductus arteriosus shunting after birth. left ventricle; patent ductus arteriosus; neonate; end-systolic meridional wall stress During the transition from fetal to neonatal circulation, the left-to-right ductus arteriosus shunting acts as a preload to the left ventricle (LV). In animal research on newborn lambs, some investigators demonstrated the less capacity of LV response to an increased preload (Klopfenstein and Rudolph 1978;Romero and Friedman 1979;Baylen et al. 1985), whereas, others demonstrated the capa-

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Left ventricular output during postnatal circulatory adaptation in healthy infants born at full term.

Cited by 41 publications

References 23 publications

Measuring Physiological Changes during the Transition to Life after Birth

Measuring Physiological Changes during the Transition to Life after Birth

Cardiac Output and Central Distribution of Blood Flow in the Human Fetus

Left Ventricular Contractile State of Early Human Neonates with Patent Ductus Arteriosus.

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