Something must happen before first breath

Abstract

Background Definition and concept of the ‘beginning of human life’ are weakened by co-existing contrasting hypotheses based on humanistic or religious beliefs rather than scientific foundations. This plethora of conceptually distant views have important common concerns in different fields of science and shape, in turn, several societal aspects including laws related, for instance, to inheritance eligibility or abortion, end-of-life care and euthanasia, and reproductive technology. Also, they are fundamental to evaluate opportunity for resuscitation vs. palliative care in extremely preterm infants. In this article, we address one of the most common tenets in medicine: the acceptance that human life starts with first breath, even though several events are well-documented to take place before its occurrence. Main text Several studies show how pivotal physiological events take place before first breath. Evidence of a number of neurological events occurring before first breath opens the way to the primacy of the Central Nervous System, given its immediate extra-uterine activation at birth. This activation eventually sets specific physiological conditions that allow the complex sequence of events determining the muscle activity associated with the influx of air in the lung and the settling of a continuous and successful extra-uterine respiration. We would like to invite the scientific community to endorse a clear-cut position against the paradigm of ‘first breath’ as the beginning of life. Herein, we also assume how, a still undefined, yet possibly specific quid in the external environment triggers further physiological response in newborns. Better understanding of the critical events that occur at the beginning of human life is likely to cause great concern and expectations in scientists, researchers and physicians working in the domain of brain, and its physiology, and mental health. Conclusions The comparison between beliefs and evidence-based observations generates confusion, misperceptions and false expectations in society, hence, in the scientific and medical community. Different and more solid alternatives about the carachterization of the ‘beginning of human life’ are indeed available and require to be explored and defined.

The Newborn's Reaction to Light as the Determinant of the Brain's Activation at Human Birth

“…This tenet is widespread and has major implications in several fields, including ethics, law, and end-of-life care. The terms and concepts revolving around birth and the beginning of human life are often flawed by multiple competing hypotheses, which tend to be based on humanistic and/or cultural beliefs rather than scientific merits (Dupont-Thibodeau and Janvier, 2016;Polese et al, 2021). Observational studies define birth's time 0 as the moment when the newborn's thorax and pelvis pass through the birth canal (Rousseau et al, 2014).…”

“…Between birth and the first breath, there is some time, about 20 s, during which the newborn does not breathe but physiological events occur, including lung fluid clearance. We assume these phenomena might represent the newborn's reaction to the new, stressful extrauterine environment, as opposed to the previous intrauterine condition, started by the central nervous system (CNS; Polese et al, 2021). Mechanisms are activated in order to initiate and sustain a number of functions that are essential for survival (Morton and Brodsky, 2016;Stroud et al, 2020;Shi et al, 2021).…”

“…This activation characterizes the newborn's physiology as soon as he or she is exposed to the extrauterine environment before the first breath happens. Time before breathing can physiologically last up to 60 s (WHO, 2012); however, the triggers of physiological events and what occurs at the CNS level at this time have not been discovered yet (Polese et al, 2021).…”

“…At birth, abrupt and intense sensory stimulation by the extrauterine environment can play an essential role in driving the subsequent development of full-brain functions. In particular, the extraordinary sensory input from the new environment can be the triggering event that activates the whole brain at birth, determining the first breath (Cohen and Katz-Salamon, 2005;Polese et al, 2021). Recently, a brainstem signaling system, which is upregulated at birth to support breathing, has been reported in experimental models (Shi et al, 2021).…”

“…Although stimuli from the external environment (Umwelt) are multifactorial (André et al, 2018), we consider that one singlespecific stimulus is likely to work as a trigger for the brain shifting from a fetal pattern of functions to a distinctive neonatal setup so as to determine the first breath (Polese et al, 2021). Given the important role of sensory input in neurodevelopment, new research has focused on the extrauterine environment's dramatic impact at birth (Tsuneishi and Casaer, 2000;Viola et al, 2011;Schwindt et al, 2018;De Asis-Cruz et al, 2020).…”