Prostaglandin E1 in infants with congenital diaphragmatic hernia (CDH) and life-threatening pulmonary hypertension

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Le Duc, Kevin | Mur, Sébastien | Sharma, Dyuti | Aubry, Estelle | Recher, Morgan | Rakza, Thameur | Storme, Laurent | Gilliot, Sixtine | Boukhris, Mohamed Riadh | Masse, Morgane | Décaudin, Bertrand | Odou, Pascal | Rousset, Céline | Vaast, Pascal | Westlynk, Nathalie | Besengez, Capucine | Garabedian, Charles | de Jonckheere, Julien

Edité par CCSD ; American Academy of Pediatrics -

International audience. Some previous studies reported a benefit to cardiopulmonary transition at birth when starting resuscitation maneuvers while the cord was still intact for a short period of time. However, the best timing for umbilical cord clamping in this condition is unknown. The aim of this study was to explore the duration of effective umbilico–placental circulation able to promote cardiorespiratory adaptation at birth during intact cord resuscitation. Umbilico–placental blood flow and vascular resistances were measured in an experimental neonatal lamb model. After a C-section delivery, the lambs were resuscitated ventilated for 1 h while the cord was intact. The maximum and mean umbilico–placental blood flow were respectively 230 ± 75 and 160 ± 12 mL·min−1 during the 1 h course of the experiment. However, umbilico–placental blood flow decreased and vascular resistance increased significantly 40 min after birth (p < 0.05). These results suggest that significant cardiorespiratory support can be provided by sustained placental circulation for at least 1 h during intact cord resuscitation.

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