TY - JOUR T1 - Effect of breathing on venous return during delayed cord clamping: an observational study JF - Archives of Disease in Childhood - Fetal and Neonatal Edition JO - Arch Dis Child Fetal Neonatal Ed SP - 65 LP - 69 DO - 10.1136/archdischild-2020-321431 VL - 107 IS - 1 AU - Emma Brouwer AU - Ronny Knol AU - Annie Kroushev AU - Thomas Van Den Akker AU - Stuart B Hooper AU - Arno A Roest AU - Arjan B te Pas Y1 - 2022/01/01 UR - http://fn.bmj.com/content/107/1/65.abstract N2 - Objective To investigate the effect of spontaneous breathing on venous return in term infants during delayed cord clamping at birth.Methods Echocardiographic ultrasound recordings were obtained directly after birth in healthy term-born infants. A subcostal view was used to obtain an optimal view of the inferior vena cava (IVC) entering the right atrium, including both the ductus venosus (DV) and the hepatic vein (HV). Colour Doppler was used to assess flow direction and flow velocity. Recordings continued until the umbilical cord was clamped and were stored in digital format for offline analyses.Results Ultrasound recordings were obtained in 15 infants, with a median (IQR) gestational age of 39.6 (39.0–40.9) weeks and a birth weight of 3560 (3195–4205) g. Flow was observed to be antegrade in the DV and HV in 98% and 82% of inspirations, respectively, with flow velocity increasing in 74% of inspirations. Retrograde flow in the DV was observed sporadically and only occurred during expiration. Collapse of the IVC occurred during 58% of inspirations and all occurred caudal to the DV inlet (100%).Conclusion Spontaneous breathing was associated with collapse of the IVC and increased antegrade DV and HV flow velocity during inspiration. Therefore, inspiration appears to preferentially direct blood flow from the DV into the right atrium. This indicates that inspiration could be a factor driving placental transfusion in infants.Data are available upon reasonable request. ER -