Physiologically based cord clamping improves cardiopulmonary haemodynamics in lambs with a diaphragmatic hernia.
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In brief
In brief
This lamb model study demonstrates that physiologically based cord clamping (PBCC)—ventilating the lungs before cutting the umbilical cord—significantly improves pulmonary blood flow and cardiopulmonary transition in congenital diaphragmatic hernia compared to immediate cord clamping, with 19-fold greater pulmonary perfusion at the time of cord separation.
Written by the GCMD Library team from the article.
OBJECTIVE: Lung hypoplasia associated with congenital diaphragmatic hernia (CDH) results in respiratory insufficiency and pulmonary hypertension after birth. We have investigated whether aerating the lung before removing placental support (physiologically based cord clamping (PBCC)), improves the cardiopulmonary transition in lambs with a CDH.
METHODS: At ≈138 days of gestational age, 17 lambs with surgically induced left-sided diaphragmatic hernia (≈d80) were delivered via caesarean section. The umbilical cord was clamped either immediately prior to ventilation onset (immediate cord clamping (ICC); n=6) or after achieving a target tidal volume of 4 mL/kg, with a maximum delay of 10 min (PBCC; n=11). Lambs were ventilated for 120 min and physiological changes recorded.
RESULTS: Pulmonary blood flow (PBF) increased following ventilation onset in both groups, but was 19-fold greater in PBCC compared with ICC lambs at cord clamping (19±6.3 vs 1.0±0.5 mL/min/kg, p