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  • Effect of body position and ventilation on umbilical artery and venous blood flows during delayed umbilical cord clamping in preterm lambs

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Original article
Effect of body position and ventilation on umbilical artery and venous blood flows during delayed umbilical cord clamping in preterm lambs
  1. Stuart B Hooper1,2,
  2. Kelly J Crossley1,2,
  3. Valerie A Zahra1,
  4. Jeroen van Vonderen3,
  5. Alison Moxham1,
  6. Andrew W Gill4,
  7. Martin Kluckow5,
  8. Arjan B te Pas3,
  9. Euan M Wallace1,2,
  10. Graeme R Polglase1,2
  1. 1Ritchie Centre, The Hudson Institute for Medical Research, Clayton, Victoria, Australia
  2. 2Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
  3. 3Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands
  4. 4Centre for Neonatal Research and Education, The University of Western Australia, Crawley, Western Australia, Australia
  5. 5Department of Neonatology, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Professor Stuart B Hooper, The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, VIC 3168, Australia; stuart.hooper{at}monash.edu

Abstract

Objective While delayed umbilical cord clamping (UCC) is thought to facilitate placental to infant blood transfusion, the physiological factors regulating flow in the umbilical arteries and veins during delayed UCC is unknown. We investigated the effects of gravity, by changing fetal height relative to the placenta, and ventilation on umbilical blood flows and the cardiovascular transition during delayed UCC at birth.

Methods Catheters and flow probes were implanted into preterm lambs (128 days) prior to delivery to measure pulmonary, carotid, umbilical artery (UaBF) and umbilical venous (UvBF) blood flows. Lambs were placed either 10 cm below or 10 cm above the ewe. Ventilation commenced 2–3 min before UCC and continued for 30 min after UCC.

Results Gravity reduced umbilical and cerebral flows when lambs were placed below the midline, but the reduction in UaBF and UvBF was similar. Ventilation during delayed UCC reduced UvBF and UaBF by similar amounts, irrespective of the lamb's position, such that flows into and out of the placenta remained balanced. The effects of ventilation on umbilical flows were much greater than the effects of gravity, but no net placental to lamb blood transfusion could be detected under any condition. Cardiovascular parameters, cerebral oxygen kinetics and final blood volumes were similar in both groups 5 min after UCC.

Conclusions Gravity caused small transient effects on umbilical and cerebral flow, but given changes were similar in umbilical arteries and veins, no net placental transfusion was detected. Ventilation during delayed UCC has a markedly greater influence on cardiovascular function in the newborn.

  • Umbilical Cord Clamping
  • Preterm Birth
  • Resuscitation
  • umbilical artery and umbilical venous blood flows
  • delayed umbilical cord clamping

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/archdischild-2016-311159

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    Footnotes

    • Contributors Conception or design of the work: SBH, KJC, ABtP, EMW, AWG, MK and GRP. Acquisition, analysis or interpretation of data for the work: SBH, VVZ, KJC, JvV, AM, AWG, MK, ABtP, EMW and GRP. Drafting the work or revising it critically for important intellectual content: SBH, VVZ, KJC, JvV, AM, AWG, MK, ABtP, EMW and GRP.

    • Funding This research was supported by National Institutes of Health R01HD072848-01A1, National Health and Medical Research Council (NH&MRC) Program Grant (606789), NH&MRC Project Grant (1067615) NH&MRC Research Fellowships (GRP: 1105526 and SBH: 545921) and the Victorian Government's Operational Infrastructure Support Program.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.