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Статті в журналах з теми "Transition to Extrauterine life"

Автор: Grafiati

Опубліковано: 29 березня 2025

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1

Michel, Alexandra, and Nancy K. Lowe. "The Successful Immediate Neonatal Transition to Extrauterine Life." Biological Research For Nursing 19, no. 3 (January 12, 2017): 287–94. http://dx.doi.org/10.1177/1099800416685178.

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Purpose: To define and describe the processes underlying the successful neonatal transition to extrauterine life and methods to assess the transition. Method: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Web of Science, and Google Scholar were searched using a combination of the key words neonate, neonatal, newborn, transition, respiratory OR pulmonary, cardiac, metabolic, pH, umbilical cord, and assessment. Articles in English and German were reviewed. The final sample of articles consisted of one randomized controlled trial, 30 observational studies using human neonates, one observational study using rabbit pups, one secondary analysis, three systematic reviews, and 23 review articles. Major Findings: The pertinent findings in regard to normal events in the respiratory, cardiovascular, and metabolic transitions are reviewed and summarized. We address the underlying factors necessary for the transition to extrauterine life, specify the consequences of a successful transition, and review common assessment approaches. Conclusion: Available evidence indicates that the successful immediate transition to extrauterine life should be completed within 1–3 hr after birth, though some adaptive processes can fail as late as 24–48 hr after birth. Further research is necessary to identify a feasible, easily used, noninvasive method to assess the status of a neonate’s transition to extrauterine life.

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2

VanWoudenberg, Christine D., Christie A. Wills, and Lori Baas Rubarth. "Newborn Transition to Extrauterine Life." Neonatal Network 31, no. 5 (2012): 317–22. http://dx.doi.org/10.1891/0730-0832.31.5.317.

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3

Britton, John R. "The Transition to Extrauterine Life and Disorders of Transition." Clinics in Perinatology 25, no. 2 (June 1998): 271–94. http://dx.doi.org/10.1016/s0095-5108(18)30115-5.

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4

Verklan, M. Terese. "Physiologic Variability during Transition to Extrauterine Life." Critical Care Nursing Quarterly 24, no. 4 (February 2002): 41–56. http://dx.doi.org/10.1097/00002727-200202000-00006.

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5

Shutack, John G. "Pulmonary Development, Transition from Intrauterine to Extrauterine Life." Anesthesia & Analgesia 65, no. 4 (April 1986): 427. http://dx.doi.org/10.1213/00000539-198604000-00035.

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6

Carswell, F. "Pulmonary Development: Transition from Intrauterine to Extrauterine Life." British Journal of Diseases of the Chest 80 (January 1986): 309. http://dx.doi.org/10.1016/0007-0971(86)90082-3.

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7

Hillman, Noah H., Suhas G. Kallapur, and Alan H. Jobe. "Physiology of Transition from Intrauterine to Extrauterine Life." Clinics in Perinatology 39, no. 4 (December 2012): 769–83. http://dx.doi.org/10.1016/j.clp.2012.09.009.

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8

Morton, Sarah U., and Dara Brodsky. "Fetal Physiology and the Transition to Extrauterine Life." Clinics in Perinatology 43, no. 3 (September 2016): 395–407. http://dx.doi.org/10.1016/j.clp.2016.04.001.

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9

Aydin, Ruveyde. "Birth Journey of a Newborn: Transition from Intrauterine to Extrauterine Life." New Trends and Issues Proceedings on Advances in Pure and Applied Sciences, no. 8 (December 9, 2017): 01–06. http://dx.doi.org/10.18844/gjapas.v0i8.2780.

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The process of birth is an important factor that determines the kind of a person one will be in the future and how we see the world. This study examines the psychological experiences of newborns from the intrauterine to the extrauterine world. The study used English–Turkish language papers and was conducted in PubMed, Scopus, Cochrane and Google Scholar, using a combination of key words like ‘transtation extrauterine world’, ‘newborn’, ‘newborn psychology’, ‘birth and newborn’. During birth, babies undergo a lot of stress. Foetuses and babies can react to signals from their environment. Newborns listen intently to their mothers and prefer to hear those heard weeks before birth. Infants are also great dreamers, according to studies of brain waves. The newborn trauma at birth affects adult life and plays a role in many psychiatric disorders. So delivery rooms should be quieter places with dim lighting and even soft music. Keywords: Newborn, transtation, extrauterine, intrauterine life, psychology.

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10

Pandey, Suman, and Rajni Mary Bains. "NEW-BORN RESUSCITATION." International Journal of Advanced Research 10, no. 12 (December 31, 2022): 74–80. http://dx.doi.org/10.21474/ijar01/15810.

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These guidelines are planned for Health care workers who are dedicated to giving neonatal resuscitation in the health care facilities. These guidelines are designed to keep in mind the complete process from the intrauterine to the extrauterine life of a new-born. In Other words, we can say the transition from intrauterine to extrauterine life. Updated neonatal resuscitation guidelines Included the latest knowledge in neonatal resuscitation also important changes from older guidelines and sanctions by the government of India for practice in health care facilities.

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11

Baserga, M., A. Puri, C. Arora, C. Hobel, and Augusto Sola. "Nitric Oxide in Perinatal Circulation during Transition to Extrauterine Life." Pediatric Research 45, no. 4, Part 2 of 2 (April 1999): 48A. http://dx.doi.org/10.1203/00006450-199904020-00289.

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12

Hand, Ivan. "Neonatal Resuscitation in Low Volume Hospital Settings." Children 9, no. 5 (April 25, 2022): 607. http://dx.doi.org/10.3390/children9050607.

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The vast majority of term newborns will begin breathing and make a successful transition to extrauterine life, whereas a small percentage of infants will require some intervention immediately after birth by a skilled provider [...]

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13

Hand, Ivan. "Neonatal Resuscitation in Low Volume Hospital Settings." Children 9, no. 5 (April 25, 2022): 607. http://dx.doi.org/10.3390/children9050607.

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The vast majority of term newborns will begin breathing and make a successful transition to extrauterine life, whereas a small percentage of infants will require some intervention immediately after birth by a skilled provider [...]

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14

Gregory, Katherine E. "What Can the Transition to Extrauterine Life Teach Us About Change?" Journal of Perinatal & Neonatal Nursing 28, no. 2 (2014): 94–97. http://dx.doi.org/10.1097/jpn.0000000000000033.

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15

Turan, Sifa, Ozhan Turan, Mubadda Salim, Christopher Harman, and Ahmet Baschat. "192: Cardiovascular transition to extrauterine life in fetal growth restriction (FGR)." American Journal of Obstetrics and Gynecology 199, no. 6 (December 2008): S65. http://dx.doi.org/10.1016/j.ajog.2008.09.219.

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16

Turan, S., O. M. Turan, M. Salim, C. R. Harman, and A. A. Baschat. "OC175: Cardiovascular transition to extrauterine life in fetal growth restriction (FGR)." Ultrasound in Obstetrics and Gynecology 30, no. 4 (September 21, 2007): 420. http://dx.doi.org/10.1002/uog.4281.

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17

O'Reilly, Daniel, Karl Egan, Oscar Burke, Angharad Griffiths, Elaine Neary, Alfonso Blanco, Paulina Szklanna, Patricia Maguire, Naomi McCallion, and Fionnuala Ni Ainle. "The Population of Circulating Extracellular Vesicles Dramatically Alters after Very Premature Delivery- a Previously Unrecognised Postnatal Adaptation Process?" Blood 132, Supplement 1 (November 29, 2018): 1129. http://dx.doi.org/10.1182/blood-2018-99-113180.

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Анотація:

Abstract Introduction Following birth, the transition from intrauterine to extrauterine life is associated with major physiological changes. Many pathological processes linked with mortality and morbidity in preterm infants start at this time. Extracellular vesicles (EVs) are subcellular particles released by all known cell types and readily detectable in large numbers in all biological fluids. EVs are heterogeneous in size and origin, consisting of exosomes (endosomal origin, 30-150 nm), microvesicles (plasma membrane-derived, 50-1000nm), and apoptotic bodies (500-2000 nm). They are linked with a wide variety of processes including coagulation and cell-cell communication, and it has been hypothesized that they may affect preterm morbidities. It is unknown whether circulating EVs can change during this extrauterine transition period. Aim Here we investigate if the population of circulating EVs is altered in premature neonates during the extrauterine transition period Patients and Methods Preterm neonates were recruited through the Department of Neonatology at the Rotunda Hospital, Dublin, Ireland. Written informed consent was obtained from the parents of all participants. Blood collection was performed during routine phlebotomy. Platelet free plasma was prepared by double centrifugation at 3000g for 10 minutes. 15x Day 1 of life and 14x days 3 of life plasma samples were available from preterm neonates, 8 of which were matched Day 1 and Day 3 samples. EVs were quantified and characterised by both nanoparticle tracking analysis (NTA with a Malvern NanoSight 3000) and flow cytometry (Beckman Coulter CytoFLEX LX). Results The extrauterine transition period is characterised by a shift in plasma EVs profile. Using NTA, we observed an increase in the levels of plasma EVs (0-200nm) from Day 1 to Day 3 (Day 1; 4.0 ± 2.5 x 107/µl vs. Day 3; 7.2 ± 4.4 x 107/µl; p = 0.03). This increase in EV levels (0-200nm) was supported by flow cytometry, which also demonstrated an increase in EVs (100-900nm) from day 1 to Day 3 (Day 1; 1.1 ± 0.3 X 106/µl vs. Day 3; 4.2 ± 3.2 x 106/µl, p = 0.0009). There was a highly significant correlation between EV levels measured by NTA and flow cytometry (Spearmann rank correlation coefficient, r = 0.69, p < 0.0001), suggesting simultaneous increases in small and large EVs during the extrauterine transition period. Using flow cytometry, we also observed a change in the composition of plasma EVs during the extrauterine transition period. Flow cytometry data from Day 3 samples were characterised by the presence of a homogenous population of EVs of ~100-300nm in size, which was not observed on Day 1. The presence of this population caused a significant increase in the median side scatter height (SSC-H) value of the plasma EV population (Day 1; 1800 ± 746 vs. Day 3; 3832 ± 1633, p = 0.0013), as well as reduction in the percentage of 100nm EVs (Day 1; 73.9 ± 9.2 % vs. Day 3; 57.4 ± 12.6 %, p = 0.0005) and an increase in the percentage of 100-300nm EVs (Day 1; 19.7 ± 7.7 % vs. Day 3; 38.0 ± 12.9%, p = 0.001). EVs from Day 3 samples were characterised by higher median Red SSC-H values (Day 1; 1688 ± 2902 vs. Day 3; 3641 ± 6247, p = 0.0004) and Violet SSC-H values (Day 1; 42641 ± 21131 vs. Day 3; 97133 ± 38311, p < 0.0001), suggesting a potential change in the membrane or internal composition of EVs in the extrauterine transition period. We also observed a change in protein expression on EVs during the extrauterine transition period. Platelets and platelet activation play a physiological role in the closure of the ductus arteriosus . As such, we assessed the levels of platelet EVs (CD41+/Annexin V+), an established marker of platelet activation in vivo. The percentage of CD41+/Annexin V-EVs significantly decreased from Day 1 to Day 3 (Day 1; 6.5 ± 4.9 % vs. Day 3; 2.4 ± 1.9 %, p = 0.007), suggestive of a platelet activation event early in the extrauterine transition period. Proteomic differences between day 1 and day 3 were analysed using mass spectrometry analysis Conclusion In this study, we clearly demonstrate that the extrauterine transition period is characterised by major changes in plasma EVs. These changes include an increase in the levels of EVs, a change in the composition of EVs, and a reduction in the percentage of platelet-derived EVs. The physiological or pathophysiological causes of the changes require further elucidation. In addition, the role of this change of EV profile in the pathogenesis of important preterm morbidities needs to be clarified. Disclosures Ni Ainle: Leo Pharma: Research Funding; Actelion: Research Funding; Bayer: Research Funding; Bayer: Membership on an entity's Board of Directors or advisory committees; BMS: Membership on an entity's Board of Directors or advisory committees; Daiichi Sankyo: Membership on an entity's Board of Directors or advisory committees; Boehringer: Membership on an entity's Board of Directors or advisory committees.

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18

Bedwell, Susan Michelle, Renee Leasure, and Theresa Gibson. "The Effect of a Respiratory Algorithm on Respiratory Transition to Extrauterine Life." Neonatal Network 38, no. 2 (March 1, 2019): 80–87. http://dx.doi.org/10.1891/0730-0832.38.2.80.

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PurposeThis evidence-based practice project evaluated the efficacy of a respiratory algorithm administered by specially trained transition nurses on the reduction of preventable NICU admissions for infants experiencing mild respiratory distress during transition.DesignA retrospective chart review compared a cohort of newborn admission rates for seven months before and seven months after initiation of a respiratory algorithm.SampleRecords of infants were included if they were born >35 weeks' gestation, had documented mild respiratory distress after birth, required <48 hours of noninvasive respiratory support, and had a length of stay less than four days.ResultsNinety-six infants (before n = 34, after n = 62) were included. Before implementation of the respiratory algorithm, infants requiring noninvasive respiratory support were admitted to the NICU. Following implementation of the algorithm, NICU admissions for mild respiratory distress significantly decreased (86 percent), despite a concurrent increase in maternal acuity.

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19

Gill, Andrew William. "Postnatal cardiovascular adaptation." Archives of Disease in Childhood - Fetal and Neonatal Edition 104, no. 2 (July 26, 2018): F220—F224. http://dx.doi.org/10.1136/archdischild-2017-314453.

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The heart undergoes rapid transformations in function during the transition to extrauterine life. Our understanding of the adaptive physiology underlying this process is able to inform the clinical management of infants who are struggling to complete this complex transition. Much of our knowledge of the cardiac transition is derived from the preterm infant in whom the preparative adaptations are incomplete and clinical sequelae all too common. This review will re-examine the cardiac transition highlighting the physiology that drives it and suggest appropriate clinical intervention to support the process.

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20

Colwell, Alice. "To Bathe or Not to Bathe: The Neonatal Question." Neonatal Network 34, no. 4 (2015): 216–19. http://dx.doi.org/10.1891/0730-0832.34.4.216.

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AbstractAfter delivery, newborns go through a series of physiologic changes in an effort to adapt to extrauterine life, with preterm newborns more likely to experience medical problems following this transition. Neonatal hypothermia, defined as a temperature <36.5°C, is a major contributor to neonatal mortality and morbidity.1 Early bathing may be a contributing factor to hypothermia and interfere with the premature neonate’s ability to safely adapt to an extrauterine environment.2 Skin physiology, the physiologic changes that result from bathing, the importance of maintaining vernix for temperature stability, and how policy change and education-based programs for developmentally supportive care will be discussed in an attempt to improve patient care outcomes for neonates in the NICU.

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21

Chow, Jean, and Davina Douglas. "Fluid and Electrolyte Management in the Premature Infant." Neonatal Network 27, no. 6 (November 2008): 379–86. http://dx.doi.org/10.1891/0730-0832.27.6.379.

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Caring for the premature infant in the NICU requires knowledge and understanding of the physiologic adaptation to extrauterine life and how prematurity affects that transition. Nurses play an integral role in managing fluid and electrolyte balance in these infants. This article addresses postnatal adaptation and all aspects of fluid and electrolyte management of the preterm infant.

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22

Turan, Sifa, Ozhan M. Turan, Mubadda Salim, Christoph Berg, Ulrich Gembruch, Christopher R. Harman, and Ahmet A. Baschat. "Cardiovascular Transition to Extrauterine Life in Growth-Restricted Neonates: Relationship with Prenatal Doppler Findings." Fetal Diagnosis and Therapy 33, no. 2 (2013): 103–9. http://dx.doi.org/10.1159/000345092.

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23

Chan, Belinda, and Yogen Singh. "Prostaglandin E1: Infants With Critical Congenital Heart Defects." NeoReviews 25, no. 12 (December 1, 2024): e765-e779. https://doi.org/10.1542/neo.25-12-e765.

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Critical congenital heart defects (CHDs) are life-threatening cardiac lesions requiring cardiac surgery or transcatheter intervention or result in death within 28 days after birth. In infants with critical CHDs, delayed diagnosis and inappropriate management are associated with higher mortality and comorbidities. Antenatal anomaly screening and fetal echocardiography has improved the detection of fetal CHDs, which helps in perinatal management planning with multidisciplinary teams. Even with precision delivery planning, postnatal transition may affect each infant with CHDs differently depending on the variants and severity of the defect. Therefore, it is important to have a thorough understanding of the hemodynamic physiology in infants with a critical CHD during the transition from intrauterine to extrauterine life and alter management accordingly. This review summarizes the care of infants with critical CHDs in the immediate transition period with a focus on cases with distinctive physiology.

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24

Nastase, Leonard, Carmen Elena Condrat, Mihaela Gabriela Stefan, Lavinia Gusa, Dragos Cretoiu, Vlad Dima, Nicolae Suciu, and Silvia-Maria Stoicescu. "Cerebral oxygenation during the period of transition to extrauterine life after natural versus cesarean birth." Romanian Journal of Medical Practice 17, no. 4 (December 31, 2022): 167–75. http://dx.doi.org/10.37897/rjmp.2022.4.3.

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Objective. We aim to evaluate the implications of cesarean delivery compared to natural birth by analyzing newborns’ systemic and cerebral oxygenation levels during the first 10 minutes of life. Design. This paper presents a 4-year prospective cohort study. Setting. Polizu Maternity, "Alessandrescu-Rusescu" National Institute for Mother and Child's Protection, Bucharest, Romania. Patients. Randomly selected pregnant women and their fetuses. Interventions. During the 10 min following umbilical cord clamping, regional cerebral oxygen saturation (rcSO2) was measured using the INVOS 5100 device and peripheral oxygen saturation (SpO2) was determined using the Masimo SET pulse oximeter in neonates from cesarean and natural deliveries. Main outcome measures. The cerebral fractional tissue oxygen extraction (cFTOE) in the first 10 minutes of life was calculated based on these values. Results. Newborns delivered vaginally showed higher rcSO2 levels at 1 minute of life than those born via C-section (40.5 ± 16.5% vs 33.7 ± 14.8%, AUC = 0.625; IC 95%: 0.506 - 0.743; p = 0.043). Neonatal cFTOE at 1 minute of life was significantly higher in caesarean-delivered newborns versus naturally born neonates (0.40 ± 0.25 vs 0.50 ± 0.19, p = 0.03; AUC = 0.638; IC 95%: 0.517-0.758; p = 0.023). Conclusions. Prelabor cesarean delivery seemingly plays a significant role in the process of fetal and neonatal cerebral oxygenation immediately postnatally, which is highlighted by lower rcSO2 and higher cFTOE values. Cerebral oxygen saturation monitoring in the delivery room allows the optimization of oxygen therapy in order to prevent the consequences of hypoxia or hyperoxia.

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25

Zanardo, Vincenzo, David Giarrizzo, Francesca Volpe, Lara Giliberti, and Gianluca Straface. "Emu oil-based lotion effects on neonatal skin barrier during transition from intrauterine to extrauterine life." Clinical, Cosmetic and Investigational Dermatology Volume 10 (August 2017): 299–303. http://dx.doi.org/10.2147/ccid.s133484.

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Weindling, A. Michael. "Outcome of ELGANS after a protocol to assist preterm infants in their transition to extrauterine life." Acta Paediatrica 101, no. 12 (November 8, 2012): 1198–99. http://dx.doi.org/10.1111/apa.12048.

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27

Белкин, А. М., С. Т. Кизатова, and Ю. А. Устинович. "Clinical Aspects of Newborn's Haemodynamics in the Neonatal Period." Репродуктивное здоровье. Восточная Европа 14, no. 1 (February 15, 2024): 80–97. http://dx.doi.org/10.34883/pi.2024.14.1.009.

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Наиболее значительная и радикальная адаптация человека к изменениям условий жизни происходит за время первых вдохов, когда плод переходит из внутриутробной во внеутробную среду с существенной перестройкой гемодинамики. При доношенном сроке беременности успешный постнатальный переход осуществляется за счет снижения легочного сосудистого сопротивления после раскрытия легких, повышения системного сосудистого сопротивления в результате пережатия плаценты и последующего закрытия фетальных коммуникаций. Перенаправление кровотока, воздействие повышенного парциального давления кислорода в крови и нейроэндокринный всплеск способствуют значительному перераспределению системного и органного кровотока для удовлетворения метаболических и функциональных потребностей внеутробной жизни. У недоношенного ребенка на нормальный физиологический переход влияют несколько факторов, включая, в частности, незрелость систем органов, состояние матери и принимаемые ею препараты, время пережатия пуповины и реанимационные маневры. Понимание этого сложного процесса имеет решающее значение для выхаживания недоношенных новорожденных, особенно в условиях неонатальной интенсивной терапии. The most significant and radical human adaptation to changes in living conditions occurs during the first breaths, when the foetus transitions from the intrauterine to the extrauterine environment with a significant restructuring of haemodynamics. In premature gestation, successful postnatal transition is due to a decrease in pulmonary-vascular resistance after lung opening, an increase in systemic vascular resistance as a result of placental constriction and subsequent closure of fetal communications. Redirection of blood flow, exposure to increased partial pressure of oxygen in the blood and neuroendocrine surge contribute to a significant redistribution of systemic and organ blood flow to meet the metabolic and functional needs of extrauterine life. In the preterm infant, several factors affect the normal physiological transition, including immaturity of organ systems, maternal condition and medications, timing of cord clamping and resuscitative manoeuvres, among others. Understanding this complex process is critical for nursing premature neonates, especially in the neonatal intensive care setting.

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Mellor, David. "Preparing for Life After Birth: Introducing the Concepts of Intrauterine and Extrauterine Sensory Entrainment in Mammalian Young." Animals 9, no. 10 (October 18, 2019): 826. http://dx.doi.org/10.3390/ani9100826.

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Presented is an updated understanding of the development of sensory systems in the offspring of a wide range of terrestrial mammals, the prenatal exposure of those systems to salient stimuli, and the mechanisms by which that exposure can embed particular sensory capabilities that prepare newborns to respond appropriately to similar stimuli they may encounter after birth. Taken together, these are the constituents of the phenomenon of “trans-natal sensory continuity” where the embedded sensory capabilities are considered to have been “learnt” and, when accessed subsequently, they are said to have been “remembered”. An alternative explanation of trans-natal sensory continuity is provided here in order to focus on the mechanisms of “embedding” and “accessing” instead of the potentially more subjectively conceived outcomes of “learning” and “memory”. Thus, the mechanistic concept of “intrauterine sensory entrainment” has been introduced, its foundation being the well-established neuroplastic capability of nervous systems to respond to sensory inputs by reorganising their neural structures, functions, and connections. Five conditions need to be met before “trans-natal sensory continuity” can occur. They are (1) sufficient neurological maturity to support minimal functional activity in specific sensory receptor systems in utero; (2) the presence of sensory stimuli that activate their aligned receptors before birth; (3) the neurological capability for entrained functions within specific sensory modalities to be retained beyond birth; (4) specific sensory stimuli that are effective both before and after birth; and (5) a capability to detect those stimuli when or if they are presented after birth in ways that differ (e.g., in air) from their presentation via fluid media before birth. Numerous beneficial outcomes of this process have been reported for mammalian newborns, but the range of benefits depends on how many of the full set of sensory modalities are functional at the time of birth. Thus, the breadth of sensory capabilities may be extensive, somewhat restricted, or minimal in offspring that are, respectively, neurologically mature, moderately immature, or exceptionally immature at birth. It is noted that birth marks a transition from intrauterine sensory entrainment to extrauterine sensory entrainment in all mammalian young. Depending on their neurological maturity, extrauterine entrainment contributes to the continuing maturation of the different sensory systems that are operational at birth, the later development and maturation of the systems that are absent at birth, and the combined impact of those factors on the behaviour of newborn and young mammals. Intrauterine sensory entrainment helps to prepare mammalian young for life immediately after birth, and extrauterine sensory entrainment continues this process until all sensory modalities develop full functionality. It is apparent that, overall, extrauterine sensory entrainment and its aligned neuroplastic responses underlie numerous postnatal learning and memory events which contribute to the maturation of all sensory capabilities that eventually enable mammalian young to live autonomously.

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Laube, Mandy, Miriam Bossmann, and Ulrich H. Thome. "Glucocorticoids Distinctively Modulate the CFTR Channel with Possible Implications in Lung Development and Transition into Extrauterine Life." PLOS ONE 10, no. 4 (April 24, 2015): e0124833. http://dx.doi.org/10.1371/journal.pone.0124833.

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30

Verklan, M. Terese, and Nikhil S. Padhye. "Spectral Analysis of Heart Rate Variability: An Emerging Tool for Assessing Stability During Transition to Extrauterine Life." Journal of Obstetric, Gynecologic & Neonatal Nursing 33, no. 2 (March 2004): 256–65. http://dx.doi.org/10.1177/0884217504263301.

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Ionescu, C., A. Matei, A. Doana, M. T. Dimitriu, L. Ples, and C. G. Herghelegiu. "EP02.36: Amniotic fluid pocket and premature rupture of membranes, a milestone in newborn transition to extrauterine life." Ultrasound in Obstetrics & Gynecology 54, S1 (September 30, 2019): 241–42. http://dx.doi.org/10.1002/uog.21137.

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Stamoulos, Suzanne, and Rachel Lavelle. "Neonatal resuscitation: ‘room side to motherside’." British Journal of Midwifery 27, no. 11 (November 2, 2019): 716–28. http://dx.doi.org/10.12968/bjom.2019.27.11.716.

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Delayed clamping of the neonatal umbilical cord is considered beneficial to the transition to extrauterine life in a term, uncomplicated birth. However, some neonates require resuscitation and the ability to perform this is a fundamental aspect of midwifery practice. The decision to clamp and cut the umbilical cord often precludes any resuscitative attempt, but the reasoning for this action is unclear. This article explores the purpose and place of leaving the umbilical cord intact during neonatal resuscitation. It considers the physiological basis for delaying cord clamping as well as the psychological benefits to baby, mother and family of leaving the cord intact until resuscitation is complete.

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Roeper, Marcia, Henrike Hoermann, Lisa M. Körner, Marvin Sobottka, Ertan Mayatepek, Sebastian Kummer, and Thomas Meissner. "Transitional Neonatal Hypoglycemia and Adverse Neurodevelopment in Midchildhood." Obstetrical & Gynecological Survey 79, no. 9 (September 2024): 504–6. http://dx.doi.org/10.1097/01.ogx.0001069168.19176.4b.

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(Abstracted from JAMA Network Open 2024;7:e243683) The most common metabolic condition requiring treatment in neonates is hypoglycemia, with a reported incidence of 15% among all neonates and 50% among neonates with preexisting risk factors. Transitional hypoglycemia is the most common form, occurring due to the metabolic stress directly after birth in transitioning from intrauterine to extrauterine life.

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Scipioni, Angela, Mauro Giorgi, Valeria Nuccetelli, and Stefania Stefanini. "Immunohistochemical Localisation of PDE5 in Rat Lung during Pre- and Postnatal Development." Journal of Biomedicine and Biotechnology 2009 (2009): 1–7. http://dx.doi.org/10.1155/2009/932961.

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In mammalian lung, at the transition to extrauterine life, NO/cGMP signal transduction system is known to play crucial roles in the regulation of vascular resistance and is supposed to act in angiogenesis. PDE5, which is the most abundant cGMP metabolizing enzyme within the lung, is highly expressed in the perinatal period, but its localisation in the different pulmonary cells is still poorly known. In our research, PDE5 immunohistochemical distribution was investigated in foetal and neonatal rat lung. The highest expression of PDE5 was found in cells randomly located in the stroma; in newborns, in particular, many cells in the intersaccular walls were heavily labelled, while much lower staining levels were shown by smooth myocytes belonging to vessels and airways. On the basis of their immunoreactivity for -SM actin and/or desmin, most of the heavily PDE5-positive cells were identified as interstitial myofibroblasts and transitional pericytes, while only a few were interpreted as interstitial lipofibroblasts.

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Narvey, Michael R., and Seth D. Marks. "The screening and management of newborns at risk for low blood glucose." Paediatrics & Child Health 24, no. 8 (December 2019): 536–44. http://dx.doi.org/10.1093/pch/pxz134.

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Abstract Hypoglycemia in the first hours to days after birth remains one of the most common conditions facing practitioners across Canada who care for newborns. Many cases represent normal physiologic transition to extrauterine life, but another group experiences hypoglycemia of longer duration. This statement addresses key issues for providers of neonatal care, including the definition of hypoglycemia, risk factors, screening protocols, blood glucose levels requiring intervention, and managing care for this condition. Screening, monitoring, and intervention protocols have been revised to better identify, manage, and treat infants who are at risk for persistent, recurrent, or severe hypoglycemia. The role of dextrose gels in raising glucose levels or preventing more persistent hypoglycemia, and precautions to reduce risk for recurrence after leaving hospital, are also addressed. This statement differentiates between approaches to care for hypoglycemia during the ‘transitional’ phase—the first 72 hours post-birth—and persistent hypoglycemia, which occurs or presents for the first time past that point.

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Luecke, Caitlyn, and Christopher McPherson. "Treatment of Persistent Pulmonary Hypertension of the Newborn: Use of Pulmonary Vasodilators in Term Neonates." Neonatal Network 36, no. 3 (2017): 160–70. http://dx.doi.org/10.1891/0730-0832.36.3.160.

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AbstractPersistent pulmonary hypertension of the newborn (PPHN) represents a challenging condition associated with significant morbidity. A successful transition from intrauterine to extrauterine life is contingent on adequate pulmonary vasodilation. Several pathophysiologies contribute to the failure of this cascade and may result in life-threatening hypoxia and acidosis in the newborn. Management includes optimal respiratory support, adequate sedation and analgesia, and support of vascular tone and cardiac function. Pulmonary vasodilation has the potential to overcome the cycle of hypoxia and acidosis, improving outcome in these infants. Oxygen and inhaled nitric oxide represent the foundation of therapy. Tertiary pulmonary vasodilators represent a greater challenge, selecting between therapies that include prostanoids, sildenafil, and milrinone. Variable levels of evidence exist for each agent. Thorough review of available data informing efficacy and adverse effects contributes to the development of an informed approach to neonates with refractory PPHN.

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Ludington-Hoe, Susan M., Barbara L. Morrison-Wilford, Marguerite DiMarco, and Marilyn Lotas. "Promoting Newborn Safety Using the RAPPT Assessment and Considering Apgar Criteria: A Quality Improvement Project." Neonatal Network 37, no. 2 (2018): 85–95. http://dx.doi.org/10.1891/0730-0832.37.2.85.

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PurposeThe aim of this project was to evaluate the implementation of the Respiratory, Activity, Perfusion, Position, and Tone (RAPPT) instrument in assessing the infant’s transition to extrauterine life while in skin-to-skin contact (SSC).Sample/DesignNurses (n = 17) completed a pretest and posttest of RAPPT and Apgar scoring knowledge, attended an in-service about accurate scoring, and were observed during 17 deliveries when newborns were in SSC.Outcome VariablesPrimary variables were knowledge scores, use of RAPPT, and accurate RAPPT scoring. Apgar scoring was also measured.ResultsKnowledge scores increased significantly after education, RAPPT scores were correctly assessed, and 1 of 17 newborns had a sudden unexpected postnatal collapse. Apgar scoring accuracy did not change and nurses reported that their Apgar scores were based on their overall impressions of the infant instead of Apgar criteria.

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Wood, Charles E., and Maureen Keller-Wood. "The critical importance of the fetal hypothalamus-pituitary-adrenal axis." F1000Research 5 (January 28, 2016): 115. http://dx.doi.org/10.12688/f1000research.7224.1.

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The fetal hypothalamus-pituitary-adrenal (HPA) axis is at the center of mechanisms controlling fetal readiness for birth, survival after birth and, in several species, determination of the timing of birth. Stereotypical increases in fetal HPA axis activity at the end of gestation are critical for preparing the fetus for successful transition to postnatal life. The fundamental importance in fetal development of the endogenous activation of this endocrine axis at the end of gestation has led to the use of glucocorticoids for reducing neonatal morbidity in premature infants. However, the choice of dose and repetition of treatments has been controversial, raising the possibility that excess glucocorticoid might program an increased incidence of adult disease (e.g., coronary artery disease and diabetes). We make the argument that because of the critical importance of the fetal HPA axis and its interaction with the maternal HPA axis, dysregulation of cortisol plasma concentrations or inappropriate manipulation pharmacologically can have negative consequences at the beginning of extrauterine life and for decades thereafter.

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Dan, Adriana Mihaela, Magdalena Florina Mihai, and Diana Iulia Vasilescu. "Questions and controversies in the management of hypotension in preterm infants." Newborn Research & Reviews 2, no. 4 (December 31, 2024): 143–54. https://doi.org/10.37897/newborn.2024.4.5.

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Hypotension is a frequent condition that affects preterm infants during the first days of life, within the transition period to an extrauterine environment, or associated with neonatal pathology. Persistent hypotension in the neonatal period is associated with increased neonatal morbidity and mortality. Understanding neonatal hemodynamics is the first step in approaching hypotensive neonatal patients. Treating hypotension should aim to restore impaired blood flow and maintain cellular metabolism. Neonatologists should look beyond values of blood pressure and check for markers of low systemic blood flow and inadequate organ perfusion. There are many anti-hypotensive agents, but choosing the most appropriate intervention should take into consideration the underlying pathophysiologic process, the effectiveness versus side effects of the drug, and medium- and long-term developmental outcomes. This article intends to review the therapeutic options for neonatal hypotension to offer clinicians support for an evidence-based choice.

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40

Jonker, S. S., and S. Louey. "Endocrine and other physiologic modulators of perinatal cardiomyocyte endowment." Journal of Endocrinology 228, no. 1 (October 2, 2015): R1—R18. http://dx.doi.org/10.1530/joe-15-0309.

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Immature contractile cardiomyocytes proliferate to rapidly increase cell number, establishing cardiomyocyte endowment in the perinatal period. Developmental changes in cellular maturation, size and attrition further contribute to cardiac anatomy. These physiological processes occur concomitant with a changing hormonal environment as the fetus prepares itself for the transition to extrauterine life. There are complex interactions between endocrine, hemodynamic and nutritional regulators of cardiac development. Birth has been long assumed to be the trigger for major differences between the fetal and postnatal cardiomyocyte growth patterns, but investigations in normally growing sheep and rodents suggest this may not be entirely true; in sheep, these differences are initiated before birth, while in rodents they occur after birth. The aim of this review is to draw together our understanding of the temporal regulation of these signals and cardiomyocyte responses relative to birth. Further, we consider how these dynamics are altered in stressed and suboptimal intrauterine environments.

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41

Chattergoon, Natasha N. "Thyroid hormone signaling and consequences for cardiac development." Journal of Endocrinology 242, no. 1 (July 2019): T145—T160. http://dx.doi.org/10.1530/joe-18-0704.

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The fetal heart undergoes its own growth and maturation stages all while supplying blood and nutrients to the growing fetus and its organs. Immature contractile cardiomyocytes proliferate to rapidly increase and establish cardiomyocyte endowment in the perinatal period. Maturational changes in cellular maturation, size and biochemical capabilities occur, and require, a changing hormonal environment as the fetus prepares itself for the transition to extrauterine life. Thyroid hormone has long been known to be important for neuronal development, but also for fetal size and survival. Fetal circulating 3,5,3′-triiodothyronine (T3) levels surge near term in mammals and are responsible for maturation of several organ systems, including the heart. Growth factors like insulin-like growth factor-1 stimulate proliferation of fetal cardiomyocytes, while thyroid hormone has been shown to inhibit proliferation and drive maturation of the cells. Several cell signaling pathways appear to be involved in this complicated and coordinated process. The aim of this review was to discuss the foundational studies of thyroid hormone physiology and the mechanisms responsible for its actions as we speculate on potential fetal programming effects for cardiovascular health.

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42

Wynne-Edwards, Katherine, Parthiv Amin, Ruokun Zhou, Arun Sundaram, Tania Martinez-Soto, Danièle Pacaud, and Harish Amin. "Is the Correlation between Salivary Cortisol and Serum Cortisol Reliable Enough to Enable Use of Salivary Cortisol Levels in Preterm Infants?" American Journal of Perinatology 34, no. 13 (May 15, 2017): 1302–5. http://dx.doi.org/10.1055/s-0037-1603345.

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Background Newborn premature infants are susceptible to development of relative adrenal insufficiency following transition from fetal to extrauterine life. However, the best diagnostic test for adrenal insufficiency in neonates has yet to be developed. Objectives and Methods The aim of this study was (1) to assess the feasibility of obtaining sufficient saliva sample to allow measurement of cortisol by liquid chromatography coupled to tandem mass spectrometry and (2) to assess the correlation, if any, between salivary and serum cortisol in preterm infants of ≤32 weeks' gestational age at birth. Results Samples for 230 paired serum and saliva cortisol levels from 90 preterm infants were analyzed. 87.5% of samples collected had sufficient salivary volumes for measurement. Despite being statistically significant (p < 0.0001), the correlation (Spearman r = 0.674) between serum and salivary cortisol was not strong. Conclusion Salivary free cortisol measurement is feasible but cannot be used to accurately reflect serum total cortisol. Further studies comparing salivary free cortisol to serum free cortisol and establishing normative data are needed before salivary cortisol can be used for diagnostic purposes.

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Glasgow, Robert E., Georgette M. Buga, Louis J. Ignarro, Gautam Chaudhuri, and Michael A. Heymann. "Endothelium-derived relaxing factor as a mediator of bradykinin-induced perinatal pulmonary vasodilatation in fetal sheep." Reproduction, Fertility and Development 9, no. 2 (1997): 213. http://dx.doi.org/10.1071/r96084.

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Studiesin vivo in fetal sheep have shown that bradykinin is released following oxygenation of the lungs and is at least partly responsible for normal pulmonary vasodilatation in the transition from fetal to extrauterine life. Part of this action involves secondary release of prostaglandin I2 (PGI2). In various adult vessels, bradykinin also stimulates the release of a powerful endothelium-derived relaxing factor (EDRF). Studiesin vitro were designed (using a modification of the bioassay cascade superfusion technique) to determine whether non-PGI2-related perinatal pulmonary vasodilatation is mediated by an EDRF. Superfused, precontracted, endothelium-denuded strips of fetal sheep thoracic aorta and the maternal sheep main pulmonary artery served as detectors of an EDRF released from isolated, perfused fetal sheep pulmonary arteries. Bradykinin, in the presence of indomethacin to block PGI2 synthesis, caused perfused fetal pulmonary arteries to release an EDRF, which generated a dose-dependent relaxation (24% for 1·0 µM,16·8% for 0·1 µM, and 10% for 0·01 µM bradykinin). Thus, bradykinin can produce perinatal pulmonary vasodilatation via a mechanism involving the endothelium-dependent synthesis of an EDRF.

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44

Mehler, Katrin, Judith Grimme, Julia Abele, Christoph Huenseler, Bernhard Roth, and Angela Kribs. "Outcome of extremely low gestational age newborns after introduction of a revised protocol to assist preterm infants in their transition to extrauterine life." Acta Paediatrica 101, no. 12 (November 1, 2012): 1232–39. http://dx.doi.org/10.1111/apa.12015.

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45

Papile, L. A. "Outcome of extremely low gestational age newborns after introduction of a revised protocol to assist preterm infants in their transition to extrauterine life." Yearbook of Neonatal and Perinatal Medicine 2013 (2013): 40–41. https://doi.org/10.1016/j.ynpm.2013.07.020.

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46

Benitz, W. E. "Outcome of extremely low gestational age newborns after introduction of a revised protocol to assist preterm infants in their transition to extrauterine life." Yearbook of Neonatal and Perinatal Medicine 2013 (2013): 41–43. https://doi.org/10.1016/j.ynpm.2013.06.093.

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47

Aschner, Judy L., Thuy K. Smith, Nora Kovacs, Joaquim M. B. Pinheiro, and Mamta Fuloria. "Mechanisms of bradykinin-mediated dilation in newborn piglet pulmonary conducting and resistance vessels." American Journal of Physiology-Lung Cellular and Molecular Physiology 283, no. 2 (August 1, 2002): L373—L382. http://dx.doi.org/10.1152/ajplung.00032.2002.

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Bradykinin (BK) is a potent dilator of the perinatal pulmonary circulation. We investigated segmental differences in BK-induced dilation in newborn pig large conducting pulmonary artery and vein rings and in pressurized pulmonary resistance arteries (PRA). In conducting pulmonary arteries and veins, BK-induced relaxation is abolished by endothelial disruption and by inhibition of nitric oxide (NO) synthase with nitro-l-arginine (l-NA). In PRA, two-thirds of the dilation response isl-NA insensitive. Charybdotoxin plus apamin and depolarization with KCl abolish the l-NA-insensitive dilations, findings that implicate the release of endothelium-derived hyperpolarizing factor (EDHF). However, endothelium-disrupted PRA retain the ability to dilate to BK but not to ACh or A-23187. In endothelium-disrupted PRA, dilation was inhibited by charybdotoxin. Thus in PRA, BK elicits dilation by multiple and duplicative signaling pathways. Release of NO and EDHF contributes to the response in endothelium-intact PRA; in endothelium-disrupted PRA, dilation occurs by direct activation of vascular smooth muscle calcium-dependent potassium channels. Redundant signaling pathways mediating pulmonary dilation to BK may be required to assure a smooth transition to extrauterine life.

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Malaquias, Délio Tiago Martins, Juliana Fontes Beltran Paschoal, Laura Yurico Mizuno, Rafael Pinheiro Do Nascimento, Kauan Santos Amorim De Oliveira, Mariane Capeletti Alkamin, Jordana Duarte Pinto, et al. "HOW TO PERFORM EMERGENCY NEONATAL RESUSCITATION IN THE DELIVERY ROOM." International Seven Journal of Multidisciplinary 4, no. 1 (January 3, 2025): 2–17. https://doi.org/10.56238/isevmjv4n1-001.

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Neonatal resuscitation is an essential intervention to ensure survival and minimize complications in newborns who face difficulties in the transition from intrauterine to extrauterine life. Approximately 10% of newborns require some level of respiratory assistance at birth, and around 1% need advanced resuscitation measures. Well-conducted resuscitation, based on clear protocols and rapid identification of clinical signs, significantly reduces neonatal morbidity and mortality, preventing neurological damage and improving long-term outcomes. Successful neonatal resuscitation depends on structured steps, such as warming up and positioning the newborn, effective ventilation, chest compressions and, in more serious cases, the administration of medication. In addition, continuous monitoring of vital signs and post-resuscitation management are crucial to stabilizing the baby and preventing further complications. The application of evidence-based guidelines, such as those recommended by the American Academy of Pediatrics (AAP) and the Brazilian Society of Pediatrics (SBP), is indispensable for ensuring standardized and effective interventions. Continuous training of the healthcare team, through regular training and practical simulations, is an essential component for improving performance in emergency situations. The standardization of protocols in hospitals and the integration of multidisciplinary teams strengthen the clinical response and reduce intervention times. In conclusion, well-conducted neonatal resuscitation is a central element in newborn care, with a direct impact on reducing neonatal mortality and promoting a better quality of life for survivors.

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Amelio, Giacomo S., Livia Provitera, Genny Raffaeli, Ilaria Amodeo, Silvia Gulden, Valeria Cortesi, Francesca Manzoni, et al. "Proinflammatory Endothelial Phenotype in Very Preterm Infants: A Pilot Study." Biomedicines 10, no. 5 (May 20, 2022): 1185. http://dx.doi.org/10.3390/biomedicines10051185.

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Very preterm infants are exposed to prenatal inflammatory processes and early postnatal hemodynamic and respiratory complications, but limited data are available about the endothelial effect of these conditions. The present pilot study investigates the perinatal endothelial phenotype in very preterm infants (VPIs) and explores its predictive value on neonatal mortality and hemodynamic and respiratory complications. Angiopoietin 1 (Ang-1), Ang-2, E-selectin, vascular adhesion molecule 1 (VCAM-1), tissue factor (TF), and endothelin 1 (ET-1) concentrations were tested in first (T1), 3rd (T2), and 7–10th (T3) day of life in 20 VPIs using Luminex technology and compared with 14 healthy full-term infants (FTIs). Compared to FTIs, VPIs had lower Ang-1 at T1 and T2; higher Ang-2 at T1, T2, and T3; higher Ang-2/Ang-1 ratio at T1, T2, and T3; lower E-selectin at T1, T2, and T3; higher VCAM-1 at T1; higher TF at T2. No differences in concentrations were found in neonatal deaths. VPIs with hemodynamic or respiratory complications had higher Ang-2 at T3. Perinatal low Ang-1 and high Ang-2 associated with high VCAM-1 and TF in VPIs suggest a proinflammatory endothelial phenotype, resulting from the synergy of a pathological prenatal inheritance and a premature extrauterine transition.

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Domínguez-Moreno, Marta, Ángel Chimenea, María Remedios Viegas-González, Clara Morales-Muñoz, Lutgardo García-Díaz, and Guillermo Antiñolo. "A Detailed Exploration of the Ex Utero Intrapartum Treatment Procedure with Center-Specific Advancements." Surgical Techniques Development 13, no. 1 (February 23, 2024): 76–86. http://dx.doi.org/10.3390/std13010005.

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The Ex Utero Intrapartum Treatment (EXIT) procedure has long been an invaluable tool in managing complex fetal conditions requiring airway interventions during the transition from intrauterine to extrauterine life. This technical note offers an in-depth examination of the EXIT procedure, emphasizing the refinements and innovations introduced at our center. The technique focuses on meticulous preoperative assessment and uses distinctive techniques and anesthetic methodologies. A multidisciplinary team assembles to plan the EXIT procedure, emphasizing patient communication and risk discussion. Our technique involves atraumatic access to the uterine cavity, achieved through the application of a uterine progressive distractor developed for this purpose. Following the use of this distractor, vascular clamps and a stapling device (Premium Poly Cs-57 Autosuture®, Medtronic) are employed. Our anesthetic approach employs general anesthesia with epidural catheter placement. Maternal operation involves low transverse laparotomy and intraoperative ultrasonography-guided hysterotomy. Fetal exposure includes gentle extraction or external version, ensuring airway access. After securing fetal airway access, umbilical cord clamping and maternal abdominal closure conclude the procedure. By revisiting the core principles of EXIT and incorporating center-specific advancements, we enhance our understanding and technical expertise. To our knowledge, this is the first time a detailed description of the technique has been published.

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