Resuscitation with an Intact Cord Enhances Pulmonary Vasodilation and Ventilation with Reduction in Systemic Oxygen Exposure and Oxygen Load in an Asphyxiated Preterm Ovine Model

• Main Authors: Praveen Chandrasekharan, Sylvia Gugino, Justin Helman, Carmon Koenigsknecht, Lori Nielsen, Nicole Bradley, Jayasree Nair, Vikash Agrawal, Mausma Bawa, Andreina Mari Torrealba, Munmun Rawat, Satyan Lakshminrusimha
• Format: Article
• Language: English
• Published: MDPI AG 2021-04-01
• Series: Children
• Subjects: delayed cord clamping; oxygen exposure; preterm neonates
• Online Access: https://www.mdpi.com/2227-9067/8/4/307

(1) Background: Optimal initial oxygen (O₂) concentration in preterm neonates is controversial. Our objectives were to compare the effect of delayed cord clamping with ventilation (DCCV) to early cord clamping followed by ventilation (ECCV) on O₂ exposure, gas exchange, and hemodynamics in an asphyxiated preterm ovine model. (2) Methods: Asphyxiated preterm lambs (127–128 d) with heart rate < 90 bpm were randomly assigned to DCCV or ECCV. In DCCV, positive pressure ventilation (PPV) was initiated with 30–60% O₂ and titrated based on preductal saturations (SpO₂) with an intact cord for 5 min, followed by clamping. In ECCV, the cord was clamped, and PPV was initiated. (3) Results: Fifteen asphyxiated preterm lambs were randomized to DCCV (N = 7) or ECCV (N = 8). The inspired O₂ (40% ± 20% vs. 60 ± 20%), <i>p</i> < 0.05) and oxygen load (520 (IQR 414–530) vs 775(IQR 623–868), p-0.03) in the DCCV group were significantly lower than ECCV. Arterial oxygenation and carbon dioxide (PaCO₂) levels were significantly lower and peak pulmonary blood flow was higher with DCCV. (4) Conclusion: In asphyxiated preterm lambs, resuscitation with an intact cord decreased O₂ exposure load improved ventilation with an increase in peak pulmonary blood flow in the first 5 min.