Perinatal Hypoxemia and Oxygen Sensing

Mouradian, Gary; Lakshminrusimha, Satyan; Konduri, Girija G.

doi:10.1002/cphy.c190046

Cited by 9 publications

(5 citation statements)

References 306 publications

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“…The reduction in birth weight is due to direct effects of high altitude and not interactive effects with other risk factors such as maternal age, parity, body size, or prenatal care access. 20 The primary cause of reducing birth weight is the retardation of intrauterine growth rather than shortened gestation. 21 Nutritional, behavioral, and other pregnancy-specific characteristics are likely important in each location.…”

Section: Discussionmentioning

confidence: 99%

Newborns physiological differences in low- and high-altitude settings of Ecuador

Asas-Jinde

González-Andrade

2021

J Dev Orig Health Dis

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Newborns show physiological differences in low- and high-altitude settings of Ecuador; those differences are especially relevant because most important cities in Ecuador are located at high altitude, above 2500 m. This study is an epidemiological, observational, and cross-sectional research performed at San Francisco Hospital in Quito (at 2850 m) and General Hospital in Manta (at 6 m) in the Manabí province. We studied 204 full-term newborns, healthy without any prenatal comorbidities, singleton pregnancy, mestizos, and born of healthy parents born. We found significant differences between the values of red blood cells (RBC), leucocytes, hematocrit, and hemoglobin. There was a difference of 27% more in RBC, 3% at hematocrit, and 0.4 g at hemoglobin in the high-altitude cohort. The leucocyte difference is 1270 cells/µl, which means a difference of 6%. At high-altitude settings, the mean pH was lower than normal values and pO2, pCO2, and HCO3. High-altitude newborns showed RBC of > 4,500,000 cells/µl; leukocytes > 19,000; pO2 ≤ 72 mm Hg; hemoglobin > 17.50 g/dl; and hematocrit > 54%. Both cohorts showed physiological changes of transition to extrauterine life. We observed higher polycythemia, respiratory acidosis, and hypoxemia among high-altitude newborns. High-altitude setting intensifies the physiological changes in hematological and arterial blood gases parameters.

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Section: Discussionmentioning

confidence: 99%

Newborns physiological differences in low- and high-altitude settings of Ecuador

Asas-Jinde

González-Andrade

2021

J Dev Orig Health Dis

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“…Despite the same arterial PO 2 and O 2 saturation ( Figure 8 ), arterial PCO 2 is lower in Caucasians than in Sherpas, perhaps due to a blunted respiratory sensitivity to hypoxia in Sherpas. An irreversible blunted respiratory drive was observed in high-altitude natives [ 260 ] and was confirmed in preterm infants at altitude [ 261 ] and in obesity hypoventilation syndrome [ 262 ] and has been linked to the development of the so-called “happy hypoxemia” [ 263 ]. Blunting the respiratory drive appears protective in Sherpas exposed at extreme altitudes because it depresses the need for excessive ventilation, which reduces alkalosis.…”

Section: The Oxygen Cascadementioning

confidence: 99%

The Oxygen Cascade from Atmosphere to Mitochondria as a Tool to Understand the (Mal)adaptation to Hypoxia

Samaja¹,

Ottolenghi

2023

IJMS

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Hypoxia is a life-threatening challenge for about 1% of the world population, as well as a contributor to high morbidity and mortality scores in patients affected by various cardiopulmonary, hematological, and circulatory diseases. However, the adaptation to hypoxia represents a failure for a relevant portion of the cases as the pathways of potential adaptation often conflict with well-being and generate diseases that in certain areas of the world still afflict up to one-third of the populations living at altitude. To help understand the mechanisms of adaptation and maladaptation, this review examines the various steps of the oxygen cascade from the atmosphere to the mitochondria distinguishing the patterns related to physiological (i.e., due to altitude) and pathological (i.e., due to a pre-existing disease) hypoxia. The aim is to assess the ability of humans to adapt to hypoxia in a multidisciplinary approach that correlates the function of genes, molecules, and cells with the physiologic and pathological outcomes. We conclude that, in most cases, it is not hypoxia by itself that generates diseases, but rather the attempts to adapt to the hypoxia condition. This underlies the paradigm shift that when adaptation to hypoxia becomes excessive, it translates into maladaptation.

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“…Apneic episodes in preterm infants typically increase in frequency over the first 2-4 weeks of life, then stabilize and gradually decrease with increasing postnatal age (144)(145)(146). During periods of apnea or respiratory pause, hypoxia occurs and may be exacerbated by poor oxygenation due to poor gas exchange in the setting of lung diseases of prematurity (147)(148)(149). These hypoxic episodes are typically treated with supplemental oxygen, leading to cycles of hypoxia followed by overshoot hyperoxia.…”

Section: Intermittent Hypoxia and The Developing Lungmentioning

confidence: 99%

Oxygen and mechanical stretch in the developing lung: risk factors for neonatal and pediatric lung disease

et al. 2023

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Chronic airway diseases, such as wheezing and asthma, remain significant sources of morbidity and mortality in the pediatric population. This is especially true for preterm infants who are impacted both by immature pulmonary development as well as disproportionate exposure to perinatal insults that may increase the risk of developing airway disease. Chronic pediatric airway disease is characterized by alterations in airway structure (remodeling) and function (increased airway hyperresponsiveness), similar to adult asthma. One of the most common perinatal risk factors for development of airway disease is respiratory support in the form of supplemental oxygen, mechanical ventilation, and/or CPAP. While clinical practice currently seeks to minimize oxygen exposure to decrease the risk of bronchopulmonary dysplasia (BPD), there is mounting evidence that lower levels of oxygen may carry risk for development of chronic airway, rather than alveolar disease. In addition, stretch exposure due to mechanical ventilation or CPAP may also play a role in development of chronic airway disease. Here, we summarize the current knowledge of the impact of perinatal oxygen and mechanical respiratory support on the development of chronic pediatric lung disease, with particular focus on pediatric airway disease. We further highlight mechanisms that could be explored as potential targets for novel therapies in the pediatric population.

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Perinatal Hypoxemia and Oxygen Sensing

Cited by 9 publications

References 306 publications

Newborns physiological differences in low- and high-altitude settings of Ecuador

Newborns physiological differences in low- and high-altitude settings of Ecuador

The Oxygen Cascade from Atmosphere to Mitochondria as a Tool to Understand the (Mal)adaptation to Hypoxia

Oxygen and mechanical stretch in the developing lung: risk factors for neonatal and pediatric lung disease

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