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J Pediatr. 2018 Sep;200:50-57.e2. doi: 10.1016/j.jpeds.2018.04.051. Epub 2018 May 24.

Cardiopulmonary Adaptation During First Day of Life in Human Neonates.

Author information

1
Department of Pediatrics, Mount Sinai Hospital, New York, NY; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada. Electronic address: ajain@mtsinai.on.ca.
2
Department of Pediatrics, Mount Sinai Hospital, New York, NY; Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
3
Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada; The Labatt Family Heart Center, The Hospital for Sick Children, Toronto, Ontario, Canada.
4
Department of Pediatrics, Mount Sinai Hospital, New York, NY; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada; Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
5
Department of Pediatrics, Mount Sinai Hospital, New York, NY; Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada.
6
Department of Physiology, University of Toronto, Toronto, Ontario, Canada; Heart and Stroke Richard Lewar Centre of Excellence in Cardiovascular Research, Toronto, Ontario, Canada.
7
Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Pediatrics, The University of Toronto, Toronto, Ontario, Canada.
8
Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Neonatology, The Rotunda Hospital, Dublin, Ireland; School of Medicine (Department of Paediatrics), The Royal College of Surgeons in Ireland, Dublin, Ireland.
9
Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada; Critical Care, The Hospital for Sick Children, Toronto, Ontario, Canada; School of Medicine (Department of Paediatrics), The Royal College of Surgeons in Ireland, Dublin, Ireland.

Abstract

OBJECTIVE:

To characterize the natural history of cardiopulmonary physiology in the first 24 hours after birth.

STUDY DESIGN:

A prospective observational study of healthy newborns was conducted at a large tertiary perinatal center. Echocardiography was performed at <0.5, 2-3, 7-10, and 22-24 hours of age. Specifically, assessment of pulmonary vascular resistance (PVR) (pulmonary artery acceleration time [PAAT], right ventricular ejection time, right ventricular ejection time:PAAT [PVR index], and PAAT indexed to heart rate [PAATi]), ventricular outputs (right and left), and ventricular function (tricuspid annular planar excursion, right ventricular [RV] fractional area change [FAC], RV/left ventricular [LV] global peak longitudinal strain, and LV ejection fraction) were performed. One-way repeated-measures ANOVA analysis was performed for time-dependent variables.

RESULTS:

In total, 15 neonates (9 males), born at 40 ± 0.8 weeks and 3.5 ± 0.5 kg, respectively, were studied. We observed increased PAATi (P < .05) by 2-3 hours, followed by a subsequent decline in all indices of PVR (PVR index, PAATi, midsystolic notching, and right-to-left ductal flow [P < .0001]). Although right and left ventricular stroke volume increased over the study interval (P < .001), LV output remained stable. All indices of RV function (tricuspid annular planar excursion, RV fractional area change 4-chamber, and RV global peak longitudinal strain-3 chamber [P < .001]) increased during the study interval.

CONCLUSION:

The immediate transition after birth is characterized by lower PVR, reversal of the transductal shunt, and increased biventricular stroke volume. The differential adaptive response of the RV and LV is novel and may relate to loading conditions and patent ductus arteriosus closure.

KEYWORDS:

cardiac function; postnatal adaptation; pulmonary hemodynamics; pulmonary vascular resistance; systemic hemodynamics

PMID:
29803302
DOI:
10.1016/j.jpeds.2018.04.051
[Indexed for MEDLINE]

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