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105 Non-Invasive Measurements of Hemodynamic Transition at Birth
  1. JJ van Vonderen1,
  2. AA Roest2,
  3. ML Siew3,
  4. FJ Walther1,
  5. SB Hooper3,
  6. AB te Pas1
  1. 1Division of Neonatology, Department of Pediatrics
  2. 2Department of Pediatric Cardiology, Leiden University Medical Center, Leiden, The Netherlands
  3. 3Ritchie Centre, Monash University, Melbourne, VIC, Australia

Abstract

Objective To investigate the hemodynamic changes during transition at birth obtaining non-invasive physiological data in healthy term infants.

Methods In 18 newborns (GA 39 weeks (38–39)) born by a caesarian section; arterial oxygen saturation (SaO2) (preductally), heart rate (HR) and non-invasive blood pressure (BP) were measured and echocardiography using M-mode and Doppler flow was performed at 2, 5 and 10 minutes after birth.

Results Oxygen saturation and HR were within recommended target ranges. Mean BP did not change between measurement intervals (55 mm Hg at 2 min, 54 mm Hg at 5 min. and 54 mm Hg at 10 min) and was similar as BP measured at day 1. Left ventricle output (LVO) significantly increased between 2 min and 5 min (120.3 mL/kg/min (35.1) vs. 167.4 mL/kg/min (67.3); p value <0.001) but remained stable by 10 min (189.2 mL/kg/min (26.2); ns). The increase in LVO was significantly correlated to an increase in HR and left ventricle end diastolic diameter (14.3 mm at 2 min, 16.0 mm at 5 min and 16.6 mm at 10 min; p<0.001). We observed a bidirectional ductal flow in the first minutes, but large inspirations following a cry overruled the bidirectional ductal flow causing a large left to right shunting.

Conclusion At birth, the most significant hemodynamic change occurred in the first 5 minutes whereby an increase in preload and heart rate increased LVO. Inspirations had a major influence on ductal flow, causing large left to right shunting. Blood pressure at birth remained stable.

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