Journal
BRAIN SCIENCES
Volume 9, Issue 3, Pages -Publisher
MDPI
DOI: 10.3390/brainsci9030049
Keywords
hypoxic-ischaemic encephalopathy; asphyxia; neonate; cord clamping; oxygen; haemodynamic
Categories
Funding
- Australian Government Research Training Programme (RTP) Scholarship
- National Heart Foundation of Australia
- National Health and Medical Research Council (NHMRC) Fellowships [1105526]
- NHMRC Fellowships [545921, 1136216, APP1165935]
- Victorian Government's Operational Infrastructure Support Programme
- National Health and Medical Research Council of Australia [1136216] Funding Source: NHMRC
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Brain injury in the asphyxic newborn infant may be exacerbated by delayed restoration of cardiac output and oxygen delivery. With increasing severity of asphyxia, cerebral autoregulatory responses are compromised. Further brain injury may occur in association with high arterial pressures and cerebral blood flows following the restoration of cardiac output. Initial resuscitation aims to rapidly restore cardiac output and oxygenation whilst mitigating the impact of impaired cerebral autoregulation. Recent animal studies have indicated that the current standard practice of immediate umbilical cord clamping prior to resuscitation may exacerbate injury. Resuscitation prior to umbilical cord clamping confers several haemodynamic advantages. In particular, it retains the low-resistance placental circuit that mitigates the rebound hypertension and cerebrovascular injury. Prolonged cerebral hypoxia-ischaemia is likely to contribute to further perinatal brain injury, while, at the same time, tissue hyperoxia is associated with oxidative stress. Efforts to monitor and target cerebral flow and oxygen kinetics, for example, using near-infrared spectroscopy, are currently being evaluated and may facilitate development of novel resuscitation approaches.
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