Am J Physiol Heart Circ Physiol
. 2026 Jan 28.
doi: 10.1152/ajpheart.00388.2025. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/41605468/
Hemodynamics and Transplacental Oxygen Exchange During Intact Cord Resuscitation in Control and Congenital Diaphragmatic Hernia Lambs
Kévin le Duc 1 2, Florian Manœuvrier 3, Celine Rougraff 2 4, Baptiste Teillet 1 2, Patrice Maboudou 5, Anne Wojtanowski 2, Capucine Besengez 2, Geoffroy Chevalier 2 6, Louise Ghesquiere 2 6, Charles Garabedian 2 6, Sébastien Mur 1, Riadh Boukhris 1, Laurent Storme 1 2, Dyuti Sharma 2 4
Affiliations Expand
- PMID: 41605468
- DOI: 10.1152/ajpheart.00388.2025
Abstract
Objective: Evolution of gas exchange during Intact Cord Resuscitation (ICR) remains unexplored. We aimed to investigate changes in placental hemodynamics and gas exchange during ICR in lambs with and without Congenital Diaphragmatic Hernia (CDH). Study Design: Eight CDH lambs (4.2 kg, 4 females) and nine controls (3.9 kg, 3 females) underwent ICR. At 80 days gestation (term=142 days), CDH was induced by diaphragmatic incision. After c-section at term, mean arterial pressure (MAP) was monitored via an aortic catheter. Umbilico-placental blood flow (Qup) was assessed with a flow transducer on the umbilical artery. Umbilical venous pressure was recorded, and blood gases from the aorta and umbilical vein were analyzed to evaluate placental oxygen transfer. ICR was performed for 60 min, followed by cord clamping (CC). Results: Qup and umbilical venous PO2 were similar and stable in both groups up to 50 min. MAP was 20% lower in normal lambs compared to CDH lambs (p<0.05) but equalized after CC. In CDH lambs, placental oxygen transfer was maintained during ICR (2.7 [2.2-3.3]ml/kg/min). PaCO2 was unchanged during ICR (53 [50-58] mmHg) and abruptly increased after CC (83 [60-101]mmHg) (p<0.05). For control lambs, placental oxygen transfer dropped to 0 [-0.3-0.2]ml/kg/min within 20 min of starting resuscitation, coinciding with an significant increase in PaO2 (Minute 0= 16 [12;18] mmHg; Minute 20= 50 [48-105]mmHg and 75 [50;110]mmHg after CC). Conclusions: ICR may support oxygenation and carbon dioxide removal in CDH newborns through placental gas exchange.
Keywords: Adaptation to extrauterine life; PPHN; congenital diaphragmatic hernia; delayed cord clamping; intact cord resuscitation.
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