Facilitating The Physiological Transition at Birth In Term And Preterm Neonates

促进足月和早产新生儿出生时的生理转变

• 批准号: 8547734
• 负责人: Peter Graham Davis
• 金额: $ 44.37万
• 依托单位: MONASH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-19 至 2017-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8547734
• 关键词: Address; Air Sacs; Animal Model; Area; Birth; Blood Vessels; Brain; Brain Injuries; Cardiac; Cardiovascular Physiology; Cardiovascular system; Cerebrum; Collaborations; Complex; Delivery Rooms; Development; Economic Inflation; Engineering; Environmental air flow; Fetus; Guidelines; Healthcare; Human; Image; Image Analysis; Infant; Infant Care; Injury; International; Intervention; Knowledge; Life; Lung; Motion; Neonatal; Newborn Infant; Outcome; Perfusion; Perinatal; Physiological; Physiology; Premature Birth; Premature Infant; Procedures; Process; Pulmonary Gas Exchange; Recommendation; Recovery; Research; Resolution; Respiratory physiology; Resuscitation; Risk; Safety; Staging; Structure of parenchyma of lung; Time; Umbilical cord structure; Uterine Contraction; base; body position; disability; efficacy testing; experience; fetal; hemodynamics; improved; indexing; injured; lung maturation; lung volume; mortality; neonatal resuscitation; neonate; public health relevance; respiratory; response; restoration; sound

DESCRIPTION (provided by applicant): The transition from a fetus to a newborn is one of the most complex and challenging transitions that all humans have to undertake. While most infants make this transition with remarkable ease, a significant number of infants require some form of intervention to survive. But unfortunately, this intervention can inadvertently injure the infant causing life-long disability. We believe that with a better understanding of the processes involved, it is possible to minimize the risk of injury. Our primary aim is to increase our understanding of the physiology underpinning the transition from fetal to newborn life and to use this information to improve the strategies used to support infants in the delivery room, during this vital stage of their life. The recent 2010 neonatal resuscitation guidelines proposed by ILCOR has highlighted many areas of neonatal resuscitation where specific recommendations lack appropriate evidence to support current or proposed practices. We will endeavor to fill some of these critical gaps in knowledge so that improvements in neonatal health care are based on sound scientific evidence. Our unique proposal will use large and small animal models to investigate the most critical issues experienced by preterm infants during their transition to newborn life at birth. We will: (I) identify the most effective ways of initiating ventilation in te delivery room. Specifically we will focus on procedures that optimize lung recruitment, facilitate the increase in pulmonary hemodynamics and protect the brain from hemodynamic instability. (II) determine how a sustained inflation, given as the first breath after birth in severely asphyxi preterm lambs, rapidly restores cardiac function and whether this rapid response increases the risk of brain injury (III) determine the physiological basis underlying respiratory, cardiovascular and cerebral vascular improvements observed in response to delayed umbilical cord clamping, and determine the factors that alter these physiological responses. Our application incorporates a unique collaboration between clinicians, physiologists, physicists and engineers and utilizes the most advanced physiological, imaging and analytical capabilities currently available. Underpinning this application is our unique imaging capabilities, which allow for real-time assessment of lung aeration with a temporal and spatial resolution capable of imaging the smallest air sacs throughout a breath. Analysis of these images (developed by us) allows for accurate determination of regional lung volume, lung perfusion and lung tissue motion. Our proposal is focused on addressing the major issues facing clinicians and providing a strong physiological basis to improve the treatment of premature infants during the transition to newborn life at birth.

描述（由申请人提供）：从胎儿到新生儿的过渡是所有人类必须承担的最复杂和最具挑战性的过渡之一。虽然大多数婴儿可以非常轻松地完成这一转变，但有相当数量的婴儿需要某种形式的干预才能生存。但不幸的是，这种干预可能会无意中伤害婴儿，造成终身残疾。我们相信，通过更好地了解所涉及的过程，可以最大限度地减少受伤的风险。我们的主要目的是增加我们对从胎儿到新生儿生命过渡的生理学基础的理解，并利用这些信息来改善在分娩室中用于支持婴儿的策略，在他们生命的这个重要阶段。ILCOR最近提出的2010年新生儿复苏指南强调了新生儿复苏的许多领域，其中具体建议缺乏适当的证据来支持当前或拟议的做法。我们将奋进填补这些关键的知识空白，使新生儿保健的改善建立在健全的科学证据的基础上。我们独特的建议将使用大型和小型动物模型来调查早产儿在出生时过渡到新生儿生命期间所经历的最关键问题。我们将：（一）确定最有效的方法，开始通风在产房。具体来说，我们将重点关注优化肺复张，促进肺血流动力学增加和保护大脑免受血流动力学不稳定的程序。(II)确定在严重窒息的早产羔羊出生后第一次呼吸时给予持续的充气如何迅速恢复心脏功能，以及这种快速反应是否增加脑损伤的风险（III）确定呼吸、心血管 和脑血管的改善，观察延迟脐带夹紧，并确定改变这些生理反应的因素。我们的应用程序结合了临床医生，生理学家，物理学家和工程师之间的独特合作，并利用目前最先进的生理，成像和分析能力。支撑这一应用的是我们独特的成像能力，它允许实时评估肺部通气，其时间和空间分辨率能够在整个呼吸过程中对最小的气囊进行成像。对这些图像（由我们开发）的分析允许准确确定局部肺体积、肺灌注和肺组织运动。我们的建议侧重于解决临床医生面临的主要问题，并提供强有力的生理基础，以改善早产儿在出生时向新生儿生活过渡期间的治疗。