|Title of talk:||Physiology of newborn transition with an intact umbilical cord|
|Biographical Sketch:||Dr. Ronny Knol is from the Netherlands and he obtained his Medical Degree at the Radboud University Medical Centre in Nijmegen. Pediatric training was completed at the University Medical Centre Utrecht in 2009. Subsequently his specialized Neonatal training started, including one year at the University Hospital Gasthuisberg in Leuven (Belgium). He is a consultant neonatologist at the Department of Neonatology of the Sophia Children’s Hospital – Erasmus Medical Centre in Rotterdam since 2011. He developed a special interest in newborn transition and is collaborating with Dr. Arjen te Pas (Leiden University Medical Centre) on this subject. Together they coordinate the Aeration, Breathing and then Clamping project.|
|Lecture Abstract:||Preterm infants are most vulnerable immediately after birth and the management in the first minutes of life can have a major impact on important morbidities associated with prematurity (1). During the transition to life after birth, lung aeration is pivotal for the physiological changes in respiratory and cardiovascular function that are required for survival after birth (2). However, most preterm infants fail to aerate their immature lungs and cord clamping is then required to transfer apnoeic preterm infants to a resuscitation table to provide respiratory support.
Studies in preterm infants have shown that delayed cord clamping (DCC) reduces the risk of important preterm morbidities (3). Moreover, experimental studies demonstrated that DCC until after ventilation onset sustains preload and cardiac output and avoids the large disturbances in systemic and cerebral hemodynamics during transition (4). Preterm infants could potentially benefit from this approach.
Ongoing (pre-)clinical research in preterm transition is focusing on initiating respiratory support with an intact umbilical cord, still mostly using a time-based cord clamping approach (5, 6). Using a respiratory function monitor during transition will be helpful to assess adequate spontaneous breathing. This Aeration, Breathing and then Clamping (ABC) approach might optimize cardiorespiratory transition and result in a more physiology-based cord clamping.
|References:||1. Polglase GR, Miller SL, Barton SK, Kluckow M, Gill AW, Hooper SB, et al. Respiratory support for premature neonates in the delivery room: effects on cardiovascular function and the development of brain injury. Pediatr Res. 2014;75(6):682-8.
2. Siew ML, Wallace MJ, Kitchen MJ, Lewis RA, Fouras A, Te Pas AB, et al. Inspiration regulates the rate and temporal pattern of lung liquid clearance and lung aeration at birth. J Appl Physiol (1985). 2009;106(6):1888-95.
3. Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev. 2012(8):CD003248.
4. Polglase GR, Dawson JA, Kluckow M, Gill AW, Davis PG, Te Pas AB, et al. Ventilation onset prior to umbilical cord clamping (physiological-based cord clamping) improves systemic and cerebral oxygenation in preterm lambs. PLoS One. 2015;10(2):e0117504.
5. Katheria A, Poeltler D, Durham J, Steen J, Rich W, Arnell K, et al. Neonatal Resuscitation with an Intact Cord: A Randomized Clinical Trial. J Pediatr. 2016.
6. Pushpa-Rajah A, Bradshaw L, Dorling J, Gyte G, Mitchell EJ, Thornton J, et al. Cord pilot trial – immediate versus deferred cord clamping for very preterm birth (before 32 weeks gestation): study protocol for a randomized controlled trial. Trials. 2014;15:258.