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Optimizing Transition with Delayed Umbilical Cord Clamping and Supplemental Oxygen during Preterm Resuscitation with Perinatal Asphyxia

在围产期窒息的早产复苏过程中，通过延迟脐带夹紧和补充氧气来优化过渡

基本信息

批准号：
9975860
负责人：
Praveen Chandrasekharan
金额：
$ 7.98万
依托单位：
STATE UNIVERSITY OF NEW YORK AT BUFFALO
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-07-10 至 2022-06-30
项目状态：
已结题

项目摘要

ABSTRACT Premature babies account for 10% of births in the United States; these newborn have immature lungs and often need help breathing at birth. Surfactant deficiency, immature antioxidant system and the need for extended mechanical ventilation support can cause damage to the lungs and other organs resulting in increased morbidity and mortality. Recent studies have shown that infants born <28 weeks’ gestation had a higher risk of mortality when initially ventilated with 21% oxygen. The higher mortality was due to respiratory failure, which could be due to underdeveloped lungs, impaired oxygenation and impaired blood flow to the lungs. The Neonatal Resuscitation Program (NRP) developed by the American Academy of Pediatrics (AAP) provides guidelines for clinical treatment that sets target oxygen saturation goals. A recent study emphasized the importance of these target goals and failure to reach these targets by 5 min lead to higher mortality. The ancient practice of keeping the umbilical cord intact (attached to placenta) when a premature baby needs resuscitation could potentially help transition. In this proposal, we plan to study initiation of ventilation following preterm delivery in a fetal lamb model with low heart rate (<90/min), with 30% or 60% initial oxygen and titrate based on target oxygenation while the umbilical cord is still intact. We will compare this to resuscitation without an intact cord using similar initial oxygen concentration (30% or 60%). We will study the changes at transition by measuring oxygenation, pulmonary and cerebral blood flow and oxidative injury in these 4 groups. In this way, we can compare physiologic changes and the resultant oxidative stress markers to better understand what may be happening during the human preterm transition. Optimizing the initial oxygen exposure with an intact cord in a depressed preterm animal model examines this problem in a controlled way. Real-time continuous measurements of cerebral oximetry, systemic and pulmonary flow and pressure variations during the preterm transition will contribute to reducing morbidity and mortality in these babies. Relevance to current practice in neonatal resuscitation: Establishing good oxygen supply following birth is critical and it is more difficult to achieve with premature lung disease. Current AAP-NRP guidelines are vigilant to protect newborns from oxidative stress injury by targeting oxygen saturation ranges and limiting exposure to high oxygen concentrations. This newer approach examines physiology at birth in preterm lambs to establish optimal oxygen requirements with an intact umbilical cord to achieve the transition to air breathing with minimal oxidative damage.

摘要早产儿占美国出生婴儿的10%;这些新生儿有不成熟的肺，出生时经常需要帮助呼吸。缺乏表面活性剂，抗氧化系统不成熟并且对延长的机械通气支持的需要可导致对肺的损伤，导致发病率和死亡率增加。最近的研究表明胎龄小于28周的婴儿在初次通气时死亡率较高，氧气较高的死亡率是由于呼吸衰竭，这可能是由于不发达的肺，受损的氧合和受损的血液流向肺部。新生儿复苏美国儿科学会（AAP）制定的NRP计划为以下方面提供了指导方针：设定目标氧饱和度目标的临床治疗。最近的一项研究强调，这些目标的重要性和未能在5分钟内达到这些目标导致更高的 mortality.当一个婴儿出生时，保持脐带完整（附着在胎盘上）的古老做法早产儿需要复苏可能有助于过渡。在这个提议中，我们计划研究胎羊早产后开始通气低心率（<90/min）模型，初始氧气为30%或60%，滴定率基于目标在脐带完好的情况下进行氧合。我们将把它与没有复苏的复苏进行比较，使用相似的初始氧浓度（30%或60%）的完整脐带。我们将研究这些变化，通过测量氧合，肺和脑血流量和氧化损伤，这四组。通过这种方式，我们可以比较生理变化和由此产生的氧化压力标志物，以更好地了解在人类早产过渡期间可能发生的事情。在抑郁性早产动物模型中使用完整脐带优化初始氧暴露以一种可控的方式来研究这个问题。实时连续测量大脑早产过渡期的血氧饱和度、体循环和肺循环流量及压力变化将有助于降低这些婴儿的发病率和死亡率。与当前新生儿复苏实践的相关性：出生后建立良好的氧气供应是至关重要的，过早的肺病目前的AAP-NRP指南警惕地保护新生儿免受通过靶向氧饱和度范围和限制暴露于高氧的氧化应激损伤浓度的这种新的方法检查早产羔羊出生时的生理学，最佳的氧气需求与一个完整的脐带，以实现过渡到空气呼吸氧化损伤最小