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  • Crossley, Kelly J  (3)
  • English  (3)
  • 2020-2024  (3)
  • 1
    Online Resource
    Online Resource
    Comparison of intraosseous and intravenous epinephrine administration during resuscitation of asphyxiated newborn lambs
    BMJ ; 2022
    In:  Archives of Disease in Childhood - Fetal and Neonatal Edition Vol. 107, No. 3 ( 2022-05), p. 311-316
    Details
    In: Archives of Disease in Childhood - Fetal and Neonatal Edition, BMJ, Vol. 107, No. 3 ( 2022-05), p. 311-316
    Abstract: Intraosseous access is recommended as a reasonable alternative for vascular access during newborn resuscitation if umbilical access is unavailable, but there are minimal reported data in newborns. We compared intraosseous with intravenous epinephrine administration during resuscitation of severely asphyxiated lambs at birth. Methods Near-term lambs (139 days’ gestation) were instrumented antenatally for measurement of carotid and pulmonary blood flow and systemic blood pressure. Intrapartum asphyxia was induced by umbilical cord clamping until asystole. Resuscitation commenced with positive pressure ventilation followed by chest compressions and the lambs received either intraosseous or central intravenous epinephrine (10 μg/kg); epinephrine administration was repeated every 3 min until return of spontaneous circulation (ROSC). The lambs were maintained for 30 min after ROSC. Plasma epinephrine levels were measured before cord clamping, at end asphyxia, and at 3 and 15 min post-ROSC. Results ROSC was successful in 7 of 9 intraosseous epinephrine lambs and in 10 of 12 intravenous epinephrine lambs. The time and number of epinephrine doses required to achieve ROSC were similar between the groups, as were the achieved plasma epinephrine levels. Lambs in both groups displayed a similar marked overshoot in systemic blood pressure and carotid blood flow after ROSC. Blood gas parameters improved more quickly in the intraosseous lambs in the first 3 min, but were otherwise similar over the 30 min after ROSC. Conclusions Intraosseous epinephrine administration results in similar outcomes to intravenous epinephrine during resuscitation of asphyxiated newborn lambs. These findings support the inclusion of intraosseous access as a route for epinephrine administration in current guidelines.
    Type of Medium: Online Resource
    ISSN: 1359-2998 , 1468-2052
    URL: Article
    DOI: 10.1136/archdischild-2021-322638
    Language: English
    Publisher: BMJ
    Publication Date: 2022
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  • 2
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    Effect of spontaneous breathing on umbilical venous blood flow and placental transfusion during delayed cord clamping in preterm lambs
    BMJ ; 2020
    In:  Archives of Disease in Childhood - Fetal and Neonatal Edition Vol. 105, No. 1 ( 2020-01), p. 26-32
    Details
    In: Archives of Disease in Childhood - Fetal and Neonatal Edition, BMJ, Vol. 105, No. 1 ( 2020-01), p. 26-32
    Abstract: During delayed umbilical cord clamping, the factors underpinning placental transfusion remain unknown. We hypothesised that reductions in thoracic pressure during inspiration would enhance placental transfusion in spontaneously breathing preterm lambs. Objective Investigate the effect of spontaneous breathing on umbilical venous flow and body weight in preterm lambs. Methods Pregnant sheep were instrumented at 132–133 days gestational age to measure fetal common umbilical venous, pulmonary and cerebral blood flows as well as arterial and intrapleural (IP) pressures. At delivery, doxapram and caffeine were administered to promote breathing. Lamb body weights were measured continuously and breathing was assessed by IP pressure changes. Results In 6 lambs, 491 out of 1117 breaths were analysed for change in body weight. Weight increased in 46.6% and decreased in 47.5% of breaths. An overall mean increase of 0.02±2.5 g per breath was calculated, and no net placental transfusion was observed prior to cord clamping (median difference in body weight 52.3 [−54.9–166.1] g, p=0.418). Umbilical venous (UV) flow transiently decreased with each inspiration, and in some cases ceased, before UV flow normalised during expiration. The reduction in UV flo w was positively correlated with the standardised reduction in (IP) pressure, increasing by 109 mL/min for every SD reduction in IP pressure. Thus, the reduction in UV flow was closely related to inspiratory depth. Conclusions Spontaneous breathing had no net effect on body weight in preterm lambs at birth. UV blood flow decreased as inspiratory effort increased, possibly due to constriction of the inferior vena cava caused by diaphragmatic contraction, as previously observed in human fetuses.
    Type of Medium: Online Resource
    ISSN: 1359-2998 , 1468-2052
    URL: Article
    DOI: 10.1136/archdischild-2018-316044
    Language: English
    Publisher: BMJ
    Publication Date: 2020
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  • 3
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    Single versus continuous sustained inflations during chest compressions and physiological-based cord clamping in asystolic lambs
    BMJ ; 2022
    In:  Archives of Disease in Childhood - Fetal and Neonatal Edition Vol. 107, No. 5 ( 2022-09), p. 488-494
    Details
    In: Archives of Disease in Childhood - Fetal and Neonatal Edition, BMJ, Vol. 107, No. 5 ( 2022-09), p. 488-494
    Abstract: The feasibility and benefits of continuous sustained inflations (SIs) during chest compressions (CCs) during delayed cord clamping (physiological-based cord clamping; PBCC) are not known. We aimed to determine whether continuous SIs during CCs would reduce the time to return of spontaneous circulation (ROSC) and improve post-asphyxial blood pressures and flows in asystolic newborn lambs. Methods Fetal sheep were surgically instrumented immediately prior to delivery at ~139 days’ gestation and asphyxia induced until lambs reached asystole. Lambs were randomised to either immediate cord clamping (ICC) or PBCC. Lambs then received a single SI (SI sing ; 30 s at 30 cmH 2 O) followed by intermittent positive pressure ventilation, or continuous SIs (SI cont : 30 s duration with 1 s break). We thus examined 4 groups: ICC +SI sing , ICC +SI cont , PBCC +SI sing , and PBCC +SI cont . Chest compressions and epinephrine administration followed international guidelines. PBCC lambs underwent cord clamping 10 min after ROSC. Physiological and oxygenation variables were measured throughout. Results The time taken to achieve ROSC was not different between groups (mean (SD) 4.3±2.9 min). Mean and diastolic blood pressure was higher during chest compressions in PBCC lambs compared with ICC lambs, but no effect of SIs was observed. SI cont significantly reduced pulmonary blood flow, diastolic blood pressure and oxygenation after ROSC compared with SI sing . Conclusion We found no significant benefit of SI cont over SI sing during CPR on the time to ROSC or on post-ROSC haemodynamics, but did demonstrate the feasibility of continuous SIs during advanced CPR on an intact umbilical cord. Longer-term studies are recommended before this technique is used routinely in clinical practice.
    Type of Medium: Online Resource
    ISSN: 1359-2998 , 1468-2052
    URL: Article
    DOI: 10.1136/archdischild-2021-322881
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2188490-0
    Location Call Number Limitation Availability
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    Online Resource
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