title: Cardiopulmonary changes with aeration of the newborn lung.
abstract: The newborn's transition from fetal to neonatal life includes aeration of the lungs, establishment of pulmonary gas exchange and changing the fetal circulation into the adult phenotype. This review summarizes the latest research findings, which show that lung aeration, airway liquid clearance and cardiovascular changes are directly interconnected at birth. The mechanisms of airway liquid clearance at birth are reviewed and the particular importance of the transpulmonary pressure gradient during lung aeration is discussed. Further, we summarize research findings which prove that lung aeration triggers the increase in pulmonary blood flow (PBF) at birth, and how the increase in PBF secures the preload for left ventricular output. Consequently, we review animal experiments which suggest that delaying umbilical cord clamping until breathing commences facilitates hemodynamic stability during transition. These data are reviewed with respect to the clinical applicability: As lung aeration is the key to successful transition to newborn life, providing adequate respiratory support at birth must be the primary objective of neonatal staff attending to the newborn infant. Clinical studies are needed to demonstrate whether the obvious benefits of delaying cord clamping until breathing commences hold true in human babies.
authors: The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia. Electronic address: stuart.hooper@monash.edu.
authors: Stuart Brian
authors: SB
authors: Hooper
authors: The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
authors: Graeme Roger
authors: GR
authors: Polglase
authors: The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Australia; Newborn Services, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom; Department Neonatology, Charité University Medical Centre, Berlin, Germany.
authors: Charles Christoph
authors: CC
authors: Roehr
mesh_terms: D000818:Animals; D003250:Constriction; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D007231:Infant, Newborn; D008168:Lung / Q000502:physiology*; D011652:Pulmonary Circulation / Q000502:physiology*; D011659:Pulmonary Gas Exchange; D012119:Respiration; D014470:Umbilical Cord / Q000502:physiology
keywords: Cardiovascular; Newborn; PDA; Pulmonary; Transition; Umbilical