Effect of body position and ventilation on umbilical artery and venous blood flows during delayed umbilical cord clamping in preterm lambs.
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.
Ritchie Centre, The Hudson Institute for Medical Research, Clayton, Victoria, Australia.|Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
Stuart B
SB
Hooper
Ritchie Centre, The Hudson Institute for Medical Research, Clayton, Victoria, Australia.|Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
Kelly J
KJ
Crossley
Ritchie Centre, The Hudson Institute for Medical Research, Clayton, Victoria, Australia.
Valerie A
VA
Zahra
Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands.
Jeroen
J
van Vonderen
Ritchie Centre, The Hudson Institute for Medical Research, Clayton, Victoria, Australia.
Alison
A
Moxham
Centre for Neonatal Research and Education, The University of Western Australia, Crawley, Western Australia, Australia.
Andrew W
AW
Gill
Department of Neonatology, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia.
Martin
M
Kluckow
Department of Pediatrics, Leiden University Medical Centre, Leiden, The Netherlands.
Arjan B
AB
Te Pas
Ritchie Centre, The Hudson Institute for Medical Research, Clayton, Victoria, Australia.|Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
Euan M
EM
Wallace
Ritchie Centre, The Hudson Institute for Medical Research, Clayton, Victoria, Australia.|Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
Graeme R
GR
Polglase
D000818:Animals; D000831:Animals, Newborn; D062186:Arterial Pressure; D002339:Carotid Arteries / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D003250:Constriction; D023421:Models, Animal; D036801:Parturition / Q000502:physiology*; D012756:Sheep; D014470:Umbilical Cord / Q000502:physiology*; D014691:Ventilation / Q000379:methods*
Preterm Birth; Resuscitation; Umbilical Cord Clamping; delayed umbilical cord clamping; umbilical artery and umbilical venous blood flows