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Brouwer E, Knol R, Kroushev A, et al. Effect of breathing on venous return during delayed cord clamping: an observational study. Arch Dis Child Fetal Neonatal Ed. 2021;107(1):65-69doi: 10.1136/archdischild-2020-321431.
Brouwer, E., Knol, R., Kroushev, A., Van Den Akker, T., Hooper, S. B., Roest, A. A., & Te Pas, A. B. (2022). Effect of breathing on venous return during delayed cord clamping: an observational study. Archives of disease in childhood. Fetal and neonatal edition, 107(1), 65-69. https://doi.org/10.1136/archdischild-2020-321431
Brouwer, Emma, et al. "Effect of breathing on venous return during delayed cord clamping: an observational study." Archives of disease in childhood. Fetal and neonatal edition vol. 107,1 (2022): 65-69. doi: https://doi.org/10.1136/archdischild-2020-321431
Brouwer E, Knol R, Kroushev A, Van Den Akker T, Hooper SB, Roest AA, Te Pas AB. Effect of breathing on venous return during delayed cord clamping: an observational study. Arch Dis Child Fetal Neonatal Ed. 2022 Jan;107(1):65-69. doi: 10.1136/archdischild-2020-321431. Epub 2021 Jun 09. PMID: 34108193.
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Arch Dis Child Fetal Neonatal Ed. 2022 Jan;107(1):65-69. doi: 10.1136/archdischild-2020-321431. Epub 2021 Jun 09.

Effect of breathing on venous return during delayed cord clamping: an observational study.

Archives of disease in childhood. Fetal and neonatal edition

Emma Brouwer, Ronny Knol, Annie Kroushev, Thomas Van Den Akker, Stuart B Hooper, Arno A Roest, Arjan B Te Pas

Affiliations

  1. Neonatology, Leiden University Medical Center Willem Alexander Children's Hospital, Leiden, The Netherlands [email protected].
  2. Neonatology, Leiden University Medical Center Willem Alexander Children's Hospital, Leiden, The Netherlands.
  3. Neonatology, Erasmus MC, Rotterdam, The Netherlands.
  4. Monash Women's, Monash Health, Clayton, Victoria, Australia.
  5. Obstetrics, Leids Universitair Medisch Centrum, Leiden, The Netherlands.
  6. The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.
  7. Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.
  8. Pediatric Cardiology, Leiden University Medical Center Willem Alexander Children's Hospital, Leiden, The Netherlands.

PMID: 34108193 DOI: 10.1136/archdischild-2020-321431

Abstract

OBJECTIVE: To investigate the effect of spontaneous breathing on venous return in term infants during delayed cord clamping at birth.

METHODS: Echocardiographic ultrasound recordings were obtained directly after birth in healthy term-born infants. A subcostal view was used to obtain an optimal view of the inferior vena cava (IVC) entering the right atrium, including both the ductus venosus (DV) and the hepatic vein (HV). Colour Doppler was used to assess flow direction and flow velocity. Recordings continued until the umbilical cord was clamped and were stored in digital format for offline analyses.

RESULTS: Ultrasound recordings were obtained in 15 infants, with a median (IQR) gestational age of 39.6 (39.0-40.9) weeks and a birth weight of 3560 (3195-4205) g. Flow was observed to be antegrade in the DV and HV in 98% and 82% of inspirations, respectively, with flow velocity increasing in 74% of inspirations. Retrograde flow in the DV was observed sporadically and only occurred during expiration. Collapse of the IVC occurred during 58% of inspirations and all occurred caudal to the DV inlet (100%).

CONCLUSION: Spontaneous breathing was associated with collapse of the IVC and increased antegrade DV and HV flow velocity during inspiration. Therefore, inspiration appears to preferentially direct blood flow from the DV into the right atrium. This indicates that inspiration could be a factor driving placental transfusion in infants.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Keywords: cardiology; neonatology; physiology

Conflict of interest statement

Competing interests: None declared.

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