Resuscitation of Term Compromised and Asphyctic Newborns: Better with Intact Umbilical Cord?

The authors hypothesize that particularly severely compromised and asphyctic term infants in need of resuscitation may benefit from delayed umbilical cord clamping (after several minutes). Although evidence is sparse, the underlying pathophysiological mechanisms support this assumption. For this review the authors have analyzed the available research. Based on these data they conclude that it may be unfavorable to immediately clamp the cord of asphyctic newborns (e.g., after shoulder dystocia) although recommended in current guidelines to provide quick neonatological support. Compression of the umbilical cord or thorax obstructs venous flow to the fetus more than arterial flow to the placenta. The fetus is consequently cut off from a supply of oxygenated, venous blood. This may cause not only hypoxemia and consecutive hypoxia during delivery but possibly also hypovolemia. Immediate cord clamping may aggravate the situation of the already compromised newborn, particularly if the cord is cut before the lungs are ventilated. By contrast, delayed cord clamping leads to fetoplacental transfusion of oxygenated venous blood, which may buffer an existing acidosis. Furthermore, it may enhance blood volume by up to 20%, leading to higher levels of various blood components, such as red and white blood cells, thrombocytes, mesenchymal stem cells, immunoglobulins, and iron. In addition, the resulting increase in pulmonary perfusion may compensate for an existing hypoxemia or hypoxia. Early cord clamping before lung perfusion reduces the preload of the left ventricle and hinders the establishment of sufficient circulation. Animal models and clinical trials support this opinion. The authors raise the question whether it would be better to resuscitate compromised newborns with intact umbilical cords. Obstetric and neonatal teams need to work even closer together to improve neonatal outcomes.

SOA-dependent N400 and P300 semantic priming effects using pseudoword primes and a delayed lexical decision.

In a previous semantic priming study, we found a semantic distance effect on the lexical-decision-related P300 when SOA was short (150 ms) only, but no different RT and N400 priming effects between short and long (700 ms) SOAs. To investigate this further, we separated priming from lexical decision, using a delayed lexical decision in the present study. In the short SOA only, primed targets evoked an early peaking (approximately 480 ms) P300-like component, probably because the subject detected the semantic relationship implicitly. We hypothesize that in tasks requiring an immediate lexical decision, this early P300 and the later lexical decision P300 (approximately 600 ms) are additive. Secondly, we found both a direct and an indirect priming effect for both SOAs for the ERP amplitude of the N400 time window. However the N400 component itself was considerably larger in the long SOA than in the short SOA. We interpreted this finding as an ERP correlate for deeper semantic processing in the long SOA, due to increased attention that was provoked by the use of pseudoword primes. In contrast, in the short SOA, subjects might have used a shallowed semantic processing. N400, P300, and RTs are sensitive to semantic priming-but the modulation patterns are not consistent. This raises the question as to which variable reflects an immediate physiological correlate of semantic priming, and which variable reflects co-occurring processes associated with semantic priming.

Response execution in lexical decision tasks obscures sex-specific lateralization effects in language processing: evidence from event-related potential measures during word reading.

A common hypothesis about sex differences in language processing attributes these differences to a bilateral contribution of language-related brain areas in females and a left-hemispheric dominated activation in males. However, most imaging studies failed to find such a generalized lateralization effect and reported a left-lateralized activation in both sexes instead. In a previous semantic priming study, we found a sustained (approximately 190-640 ms) bilateral positivity in the ERP waveforms, which was larger for the female group. Word reading and lexical decision were confounded in that study. In the present study we used a delayed response to separate semantic processing from response selection and execution. The modification of the task design, together with a dense sensor array, showed that females developed a bilateral sustaining posterior positivity/frontal negativity during reading/semantic processing. In contrast, males showed an attenuated positivity at left posterior sites and an attenuated negativity at right frontal sites. This sex-specific lateralization effect disappeared during response processing, evoking a bilaterally distributed activation for both sexes (frontal negative and posterior positive), which was larger for the female subjects. We conclude that, at least under specific conditions, language processing evokes a bilateral activation in females and a lateralization effect in males. However, the processing of the response, which is dominated by a 'P300-like' component evoked by this process, evokes a larger activation in both sexes which obscures the sex-specific lateralization effect when semantic processing and response processing are not separated.