Tracheal suctioning improves gas exchange but not hemodynamics in asphyxiated lambs with meconium aspiration.

BACKGROUND: Current neonatal resuscitation guidelines recommend tracheal suctioning of nonvigorous neonates born through meconium-stained amniotic fluid. METHODS: We evaluated the effect of tracheal suctioning at birth in 29 lambs with asphyxia induced by cord occlusion and meconium aspiration during gasping. RESULTS: Tracheal suctioning at birth (n = 15) decreased amount of meconium in distal airways (53 ± 29 particles/mm(2) lung area) compared to no suction (499 ± 109 particles/mm(2); n = 14; P < 0.001). Three lambs in the suction group had cardiac arrest during suctioning, requiring chest compressions and epinephrine. Onset of ventilation was delayed in the suction group (146 ± 11 vs. 47 ± 3 s in no-suction group; P = 0.005). There was no difference in pulmonary blood flow, carotid blood flow, and pulmonary or systemic blood pressure between the two groups. Left atrial pressure was significantly higher in the suction group. Tracheal suctioning resulted in higher Pao2/FiO2 levels (122 ± 21 vs. 78 ± 10 mm Hg) and ventilator efficiency index (0.3 ± 0.05 vs.0.16 ± 0.03). Two lambs in the no-suction group required inhaled nitric oxide. Lung 3-nitrotyrosine levels were higher in the suction group (0.65 ± 0.03 ng/µg protein) compared with the no-suction group (0.47 ± 0.06). CONCLUSION: Tracheal suctioning improves oxygenation and ventilation. Suctioning does not improve pulmonary/systemic hemodynamics or oxidative stress in an ovine model of acute meconium aspiration with asphyxia.

Use of cardiac troponin I (cTnI) levels to diagnose severe hypoxia and myocardial injury induced by perinatal asphyxia in neonatal dogs.

Prolonged perinatal asphyxia and subsequent severe hypoxia are the main causes of mortality in neonatal dogs in the first days of life. In medicine, specific cardiac biochemical markers, such as troponin I, are used to diagnose ischemic and nonischemic myocardial injury in asphyxiated newborns after birth. Thus, the objectives of this study were to compare the levels of cardiac troponin I (cTnI) between asphyxiated and nonasphyxiated newborn dogs and evaluate the correlations of cTnI levels with the modified Apgar score, the levels of oxygen saturation, blood glucose, and lactatemia, and blood gas parameters. This study aimed to determine the possible use of cTnI as a marker of severe hypoxia and myocardial ischemic injury in neonatal dogs. Fifteen animals in a eutocic vaginal delivery group (VG), 15 animals in a cesarean section group (CG), and 13 animals in a hypoxia (asphyxiated) group (HG) were evaluated. The animals in the asphyxiated group were from dystocic deliveries and born by vaginal delivery or cesarean section. All groups were evaluated at birth and after 60 min. The newborns in the VG and CG exhibited mixed acidosis (respiratory acidosis due to increased partial pressure of CO2 (pCO2) and metabolic acidosis due to reduced pH and bicarbonate (HCO3) levels, base excess/deficit in the extracellular fluid compartment (BEecf), and increased lactate levels) due to transient physiological hypoxemia at birth. The cTnI levels in the VG and CG were within the reference standards for healthy dogs. No correlations between cTnI level and the other parameters were observed in the VG and CG. Newborns in the HG exhibited prominent mixed acidosis (p < 0.05) due to severe hypoxemia. The Apgar score and blood gas parameters showed that these dogs were born asphyxiated, and they presented low vitality and the need for resuscitation maneuvers. The cTnI levels in the HG were significantly higher than those in the VG and CG (p < 0.05) and above the reference standards for healthy dogs, which indicated ischemic myocardial injury. The cTnI level was negatively correlated (p < 0.05) with the parameters Apgar score, heart rate, peripheral oxygen saturation (sO2) level, reflex score, and total carbon dioxide (TCO2) level and positively correlated (p < 0.01) with lactate level. This study showed that asphyxiated newborn dogs have higher serum cTnI levels than nonasphyxiated newborn dogs; thus, the cTnI can be used as a marker of severe hypoxia and ischemic myocardial damage in newborn dogs.

Hypoxia - Reoxygenation in neonatal cardiac arrest: Results from experimental models.

In this review, we summarize the results of studies that investigated the effects of hypoxia and reoxygenation in cardiac arrest, including the use of different fractions of inspired oxygen, in neonatal animals. The studies were heterogenous in terms of anaesthetic regimens, and definitions of cardiac arrest and circulatory recovery. Cardiopulmonary resuscitation with 100% oxygen increased oxidative stress in maturing rats. Studies in fetal/neonatal lambs and post-transitional neonatal piglets indicate no consistent differences between ventilation with 21% vs. 100% oxygen with regards to recovery times, oxygen damage or adverse events. If 21% oxygen is as effective as 100% oxygen in newborn infants with cardiac arrest requiring chest compression, the use of 21% instead of 100% oxygen could reduce morbidity and mortality in asphyxiated infants. Unanswered questions include what is the most optimal cerebral oxygen delivery during reperfusion, as well as oxygenation targets after return of spontaneous circulation.

Total plasma magnesium in healthy and critically ill foals.

Abnormalities in total Mg (tMg) concentration in plasma and/or serum are common in critically ill humans, and the association with increased mortality has been documented in several clinical studies in adults and newborns with hypoxic-ischemic encephalopathy. Abnormalities in tMg were studied in hospitalized dogs, cats, and adult horses. Newborn foals were scarcely studied with regard to Mg concentration. The aims of the present study were: (1) to compare two analytical methods for the determination of tMg in plasma: the automated colorimetric method and the atomic absorption spectrometry; (2) to measure plasma tMg in healthy foals during the first 72 hours after birth and in sick foals during the first 72 hours of hospitalization; (3) to compare total plasma Mg concentration among healthy foals, foals affected by perinatal asphyxia syndrome (PAS), prematurity and/or dismaturity, and sepsis; (4) to evaluate tMg plasma concentration in surviving and non-surviving foals. One hundred seventeen foals were included in the study: 20 healthy and 97 sick foals. The automated method used in clinical practice probably overestimates plasma tMg. Due to its higher sensitivity and specificity, the atomic absorption spectrometry should be considered the method of choice from an analytical point of view, but requires an instrumentation not easily available in any laboratory and specific technical skills and competencies. Plasma tMg in healthy foals were included in the range 0.52 to 1.01 mmol/L and did not show any time-dependent change during the first 72 hours of life. In sick foals, tMg evaluated at T0 was statistically higher than tMg measured at subsequent times. Foals affected by PAS had a tMg at T0 significantly higher (P < 0.01) than healthy, septic, and premature and/or dysmature foals. The t test found significantly higher (P < 0.01) plasma tMg measured at T0 in non-surviving than in surviving foals. Plasma tMg could be a useful parameter for the diagnosis of PAS and the formulation of the prognosis in critically ill foals.

Perinatal asphyxia pathophysiology in pig and human: a review.

In utero fetuses are evidently exposed to several factors that cause an interruption of the oxygen flow through the umbilical cord causing asphyxia leading to hypoxia and metabolic acidosis. These conditions are important causes of intra-partum and neonatal mortality. The main objective of this review is to provide current information regarding the pathophysiology of asphyxia in piglets around parturition; the physiological mechanisms invoked by affected piglets to compensate perinatal hypoxemia are discussed. This review also addresses some similarities and differences of asphyxia between piglets and other mammals, including human neonates. Metabolic acidosis and hypoxia are sequela to asphyxia and can cause profound health effects in postnatal performance because of an abnormal suckling, a reduced absorption of colostrum and inadequate passive transfer of neonatal immunity. Acidosis also cause hypothermia, increased mortality and reduced survival in neonates. One of the first deleterious effects of intrauterine hypoxia is the expulsion of meconium into the amniotic sac leading to meconium staining of the skin, and in severe cases, meconium aspiration into the lungs. Even though there have been technological changes and improvements in husbandry, piglet mortality due to asphyxia remains a major problem. One potential alternative to reduce neonatal mortality in pigs is the monitoring of fetal stress during birth and the implemention of strategies such as the Apgar score, that is often used in human pediatrics. It is also important to consider the physiological, behavioral and biochemical changes that take place during parturition which subsequently impact the vitality, maturity and development of neonatal pigs. Understanding the pathophysiology of fetal hypoxia should help practitioners and farmers implement more effective delivery techniques aimed at reducing neonatal mortality and improving postnatal performance.

Effects of acute asphyxia at birth on subsequent heat production capacity in newborn pigs.

The effect of acute asphyxia at birth on subsequent ability to produce heat was investigated in 30 newborn pigs. A model of experimentally induced asphyxia consisting of the prevention of breathing within the first four minutes of life was used. Blood was sampled from an umbilical artery catheter within the first 75 minutes of life for blood gas, pH, glucose, lactate and catecholamine analysis. After the treatment and 24 hours later, heat production capacity, shivering intensity and rectal temperature were measured 10 degrees C below thermoneutrality. Effects on blood gas parameters were severe but transient whereas alterations in carbohydrate metabolism were maintained during the first 75 minutes (P < 0.05). Acute asphyxia at birth induced only minor alterations of thermoregulatory abilities during the first day of life: rectal temperature was lower one hour after birth (P < 0.05) and the postnatal increase in heat production capacity was less pronounced than in controls. It is suggested that the lower viability usually reported for piglets suffering from asphyxia during delivery is most likely to result from reduced vigour and colostrum intake, as well as altered carbohydrate metabolism early after birth.

Effects of the level of asphyxia during delivery on viability at birth and early postnatal vitality of newborn pigs.

Newborn pigs (n = 117) were used to provide information on the relationships of degree of asphyxia during delivery, viability at birth, and some striking aspects of postnatal vitality including survival, interval between birth and first udder contact and between birth and first suckling, rectal temperature at 24 h of life (RT24), and growth rate over the first 10 d of life. The degree of asphyxia at birth was estimated from cord blood pCO2, pH, and lactate levels. Onset of respiration, heart rate, skin color, and attempts to stand during the first minute after birth were used to estimate the viability score. Neonatal asphyxia, i.e., decreased blood pH and increased blood pCO2 and lactate, was associated with the production of unusually high levels of catecholamines. The degree of asphyxia increased with late position in the birth order (P < .01) and was higher in piglets born posteriorly (P < 0.5). Further, the average blood pCO2 within a litter increased (P < .05) with litter size. The was an inverse relationship between the degree of asphyxia and the viability score (P < .001). Highly viable piglets reached the udder more rapidly (P < .001) and had a higher RT24 (P < .001) than those of low viability. Plasma glucose concentrations increased with blood pCO2 and plasma epinephrine concentrations (P < .001). Neonatal asphyxia reduced postnatal vitality by delaying the first contact with the udder (P < .03) and was associated with a lower RT24 (P < .05), growth rate (P < .001), and survival over 10 d (P < 0.06). These variables, i.e., interval between birth and first udder contact, RT24, and growth rate, were correlated with birth weight (P < .001); RT24 was also shown to decrease (P < .001) with the time taken to reach the udder. Overall, results suggest that piglet suffering from asphyxia during delivery are less viable at birth and less prone to adapt to extrauterine life.

Histomorphometric parameters and fractal complexity of the equine placenta from healthy and sick foals.

Computer-based digital image analysis of tissue samples shows promise both to reduce the subjectivity of traditional manual tissue assessments and potentially to shorten the time required to analyze each sample. The present study used digital image analysis to investigate the histomorphometric parameters and fractal complexity of the equine placenta from healthy and sick foals. We hypothesized that the placentas of sick foals could have a different growth pattern and complexity that could be objectively estimated by their fractal dimension (FD). Fourteen placentas from 30 mares were selected in the 2013 breeding season and divided into two groups: seven mares with normal pregnancy, eutocic delivery, and healthy foals (group 1) and seven mares with normal or high-risk pregnancy, eutocic delivery and sick foals (group 2). Four mares in group 2 were classified as having a high-risk pregnancy on the basis of anamnesis and/or ultrasound findings. Clinical diagnosis of group 2 foals included perinatal asphyxia syndrome (n = 4), prematurity/dysmaturity (n = 2), and both diagnoses (n = 1). Seven out of fourteen placentas showed diffuse gross abnormalities. Grossly abnormal placentas were observed in one out of seven (14.28%) animals in group 1 and in six out of seven (85.72%) animals in group 2. Digital image analysis proved to be reliable and efficient in segmentation, calculation, outline extraction of villi as also resulted in sampled test images. The placentas of group 1 foals displayed a uniform and homogeneous villi development, as revealed by geometric parameters and FD. These results can be interpreted as a harmonic growth pattern of microcotyledons throughout the placenta in healthy foals. By contrast, the placentas of group 2 foals showed a nonuniform growth pattern and complexity with more villi and more developed villi in pregnant horn (PH) and nonpregnant horn (NPH) compared with body (B) and higher FD in NPH than in the other areas. This finding can be interpreted as a compensatory growth with increased complexity. Our results show that morphometric analysis, particularly FD measurement, can be proposed as an ancillary histological tool for equine placenta evaluation. Chorionic villi tend to have greater branching and complexity in sick than in healthy foals, particularly in the NPH. This could represent an attempt to increase the exchange area between fetal and maternal compartments of the equine placenta, and merits further investigation.

S100B immunoreactivity: a new marker of hypoxia-related cardiac damage in newborn piglets.

OBJECTIVE: The evaluation of the expression of S100B protein, in the swine heart in an experimental model of hypoxia - reoxygenation. METHODS: Normocapnic hypoxia was induced in 40 male Landrace/Large White neonatal piglets by decreasing the inspired concentration of oxygen to 6-8%. When animals developed bradycardia or severe hypotension, reoxygenation was initiated. Piglets were allocated in four groups of 10, according to the oxygen concentration they were reoxygenated with: Group 1, 2, 3 and 4 resuscitated with 18%, 21%, 40% and 100% oxygen, respectively. The animals were further classified into 4 groups according with the time required for reoxygenation: group A (<15 min); group B (16-60 min); group C (>60 min); group D (deceased animals). RESULTS: Immunostaining for S100B protein was detected in 14 out of the 40 heart samples (35%), both inside the cytoplasm of cardiomyocytes and as globular deposits in the interstitial spaces. Significant differences were observed among groups 1-4 regarding S100B expression. Reactivity for S100B in cardiac cells was detected in 50%, 50%, 10% and 33% of animals in groups 1 and 2, 3 and 4, respectively. Marked differences were also observed among groups A-D: 75%, 33%, 12% and 22% of the animals in group 1, 2, 3 and 4, respectively, showed reactivity for S100B in the heart. CONCLUSIONS: Expression of S100B protein occurred in the heart of some of newborn piglets following severe hypoxia. S100B storage in cardiomyocytes correlates with the different oxygen concentration used during reoxygenation, being higher in piglets reoxygenated with 18% and 21%, and lower in animals reoxygenated with 40% oxygen. Intermediate levels of S100B expression were found in 100% O2-treated animals. The finding of a higher percentage of S100B-immunoreactive hearts in piglets with a fast recovery and the detection of a decreased reactivity in animals with a slow and a very slow recovery clearly indicates S100B protein as an early protective factor with a positive prognostic value in asphyxiated newborn piglets.

Peripartum asphyxia.

The abysmal survival rates for the first barking foals described more than 60 years ago were probably due to the cumulative effects of asphyxia on multiple organ systems. Successful treatment of asphyxiated foals requires recognition of periparturient conditions associated with the syndrome and appreciation of the spectrum of clinicopathologic complications that can ensue.

[Adaptation disorders in newborn animals: pathogenesis and therapy. Review article]. / Adaptationsstörungen bei neugeborenen Tieren: Pathogenese und Therapie. Ubersichtsreferat.

The sympathoadrenal system of the neonate is stimulated during parturition and immediately after birth. Endogenous opioid peptides can be regarded as partial catecholamine antagonists. They have an inhibitory action on the respiratory center but may also lead to a redistribution of cerebral blood flow in favour of certain essential brain areas. The acidosis seen in connection with neonatal asphyxia stimulates a further release of catecholamines as well as opioid peptides. The therapeutic approach should lead to a rapid normalisation of respiration.

[Acidosis and clinical condition in asphyctic calves]. / Azidose und klinischer Zustand bei asphyktischen Kälbern.

In depressed calves (modified APGAR score 4-6) there is at birth an evident combined respiratory-metabolic acidosis (pH = 7.082 +/- 0.175; pCO2 = 73.3 +/- 26.8 mm Hg; BE = -10.6 +/- 7.2 mmol/l). The metabolic adaptation is completed after 6 hours, the respiratory acidosis is present up to 24 hours after delivery. In comparison to normal calves there are significant deviations in pH-values, base excess standard bicarbonate and actual bicarbonate during the whole investigation time. The carbon dioxide tensions of the depressed calves are at birth similar to those of normal calves, but in the following hours they are significantly higher. A definite relationship can be demonstrated between the 1 minute APGAR score and pH-value, base excess, standard bicarbonate and actual bicarbonate. Oxygen tension, oxygen saturation and carbon dioxide do not correlate with the clinical condition.

Intensive care of the neonatal foal.

The basic concepts of diagnosis and treatment in the abnormal neonatal foal are presented. Methods of restraint, sedation, and general nursing care are discussed, as well as more specific techniques of respiratory and circulatory system support.