title: Respiratory support for premature neonates in the delivery room: effects on cardiovascular function and the development of brain injury.
abstract: The transition to newborn life in preterm infants is complicated by immature cardiovascular and respiratory systems. Consequently, preterm infants often require respiratory support immediately after birth. Although aeration of the lung underpins the circulatory transition at birth, positive pressure ventilation can adversely affect cardiorespiratory function during this vulnerable period, reducing pulmonary blood flow and left ventricular output. Furthermore, pulmonary volutrauma is known to initiate pulmonary inflammatory responses, resulting in remote systemic involvement. This review focuses on the downstream consequences of positive pressure ventilation, in particular, interactions between cardiovascular output and the initiation of a systemic inflammatory cascade, on the immature brain. Recent studies have highlighted that positive pressure ventilation strategies are precursors of cerebral injury, probably mediated through cerebral blood flow instability. The presence of, or initiation of, an inflammatory cascade accentuates adverse cerebral blood flow, in addition to being a direct source of brain injury. Importantly, the degree of brain injury is dependent on the nature of the initial ventilation strategy used.
authors.affiliation: 1] The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia [2] Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia.
authors.forename: Graeme R
authors.initials: GR
authors.lastname: Polglase
authors.affiliation: The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia.
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Miller
authors.affiliation: The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia.
authors.forename: Samantha K
authors.initials: SK
authors.lastname: Barton
authors.affiliation: Department of Neonatalogy, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Martin
authors.initials: M
authors.lastname: Kluckow
authors.affiliation: Centre for Neonatal Research and Education, The University of Western Australia, Western Australia, Australia.
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Gill
authors.affiliation: 1] The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia [2] Department of Obstetrics and Gynecology, Monash University, Clayton, Victoria, Australia.
authors.forename: Stuart B
authors.initials: SB
authors.lastname: Hooper
authors.affiliation: The Ritchie Centre, Monash Institute of Medical Research, Monash University, Clayton, Victoria, Australia.
authors.forename: Mary
authors.initials: M
authors.lastname: Tolcos
mesh_terms: D001921:Brain / Q000098:blood supply / Q000503:physiopathology*; D003696:Delivery Rooms; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000502:physiology*; D007249:Inflammation / Q000503:physiopathology*; D008168:Lung / Q000098:blood supply* / Q000473:pathology; D011175:Positive-Pressure Respiration / Q000009:adverse effects*; D012039:Regional Blood Flow; D012119:Respiration; D016277:Ventricular Function, Left / Q000502:physiology*