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Arch Dis Child Fetal Neonatal Ed. 2019 May 23. pii: fetalneonatal-2019-316906. doi: 10.1136/archdischild-2019-316906. [Epub ahead of print]

Physiologically based cord clamping improves cardiopulmonary haemodynamics in lambs with a diaphragmatic hernia.

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The Ritchie Centre, Hudson Institute of Medical Research, Melbourne, Victoria, Australia.
Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia.
Monash Women's Service, Monash Health, Melbourne, Victoria, Australia.
Newborn Research, Neonatal Services, The Royal Women's Hospital, Melbourne, Victoria, Australia.
Neonatal Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
The Ritchie Centre, The Hudson Institute for Medical Research, Clayton, Victoria, Australia.
Department of Obstetrics and Gynaecology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands.



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.


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.


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<0.001). Cerebral tissue oxygenation was higher in PBCC than ICC lambs during the first 10 min after cord clamping (59%±4% vs 30%±5%, p<0.001). PBF was threefold higher (23±4 vs 8±2 mL/min/kg, p=0.01) and pulmonary vascular resistance (PVR) was threefold lower (0.6±0.1 vs 2.2±0.6 mm Hg/(mL/min), p<0.001) in PBCC lambs compared with ICC lambs at 120 min after ventilation onset.


Compared with ICC, PBCC prevented the severe asphyxia immediately after birth and resulted in a higher PBF due to a lower PVR, which persisted for at least 120 min after birth in CDH lambs.


congenital diaphragmatic hernia; neonatal transition; perinatal care; pulmonary hypertension

Conflict of interest statement

Competing interests: None declared.

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