Hooper Stuart Brian, Polglase Graeme Roger, Roehr Charles Christoph
The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
The Ritchie Centre, MIMR-PHI Institute of Medical Research, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Melbourne, Australia.
Paediatr Respir Rev. 2015 Jun;16(3):147-50. doi: 10.1016/j.prrv.2015.03.003. Epub 2015 Mar 17.
The newborn's transition from fetal to neonatal life includes aeration of the lungs, establishment of pulmonary gas exchange and changing the fetal circulation into the adult phenotype. This review summarizes the latest research findings, which show that lung aeration, airway liquid clearance and cardiovascular changes are directly interconnected at birth. The mechanisms of airway liquid clearance at birth are reviewed and the particular importance of the transpulmonary pressure gradient during lung aeration is discussed. Further, we summarize research findings which prove that lung aeration triggers the increase in pulmonary blood flow (PBF) at birth, and how the increase in PBF secures the preload for left ventricular output. Consequently, we review animal experiments which suggest that delaying umbilical cord clamping until breathing commences facilitates hemodynamic stability during transition. These data are reviewed with respect to the clinical applicability: As lung aeration is the key to successful transition to newborn life, providing adequate respiratory support at birth must be the primary objective of neonatal staff attending to the newborn infant. Clinical studies are needed to demonstrate whether the obvious benefits of delaying cord clamping until breathing commences hold true in human babies.
新生儿从胎儿期到新生儿期的转变包括肺的通气、肺气体交换的建立以及将胎儿循环转变为成人表型。本综述总结了最新研究结果，这些结果表明出生时肺通气、气道液体清除和心血管变化直接相互关联。本文回顾了出生时气道液体清除的机制，并讨论了肺通气过程中跨肺压力梯度的特殊重要性。此外，我们总结了研究结果，这些结果证明肺通气在出生时触发肺血流量（PBF）增加，以及PBF的增加如何确保左心室输出的前负荷。因此，我们回顾了动物实验，这些实验表明延迟脐带结扎直到开始呼吸有助于过渡期间的血流动力学稳定。本文就这些数据的临床适用性进行了综述：由于肺通气是成功过渡到新生儿期的关键，为出生时提供足够的呼吸支持必须是照顾新生儿的新生儿医护人员的首要目标。需要进行临床研究来证明延迟脐带结扎直到开始呼吸的明显益处是否适用于人类婴儿。
