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Fetal cerebral energy metabolism and electrocardiogram during experimental umbilical cord occlusion and resuscitation.

Amer-Wåhlin, Isis LU ; Nord, Anders LU ; Bottalico, Barbara; Hansson, Stefan LU ; Ley, David LU ; Marsal, Karel LU ; Ungerstedt, Urban and Nordström, Carl-Henrik LU (2010) In Journal of Maternal-Fetal & Neonatal Medicine 23(2). p.158-166
Abstract
Objective. The purpose of this experimental study was to elucidate alterations in fetal energy metabolism in relation to ECG changes during extreme fetal asphyxia, postnatal resuscitation and the immediate post-resuscitatory phase. Study design. Five near-term fetal sheep were subjected to umbilical cord occlusion until cardiac arrest followed by delivery, resuscitation and postnatal pressure-controlled ventilation. Four sheep served as sham controls and were delivered immediately after ligation of the umbilical cord. Fetal ECG was analysed online for changes of the ST segment. Fetal metabolism was monitored by intracerebral and subcutaneous microdialysis catheters. Results. Fetal ECG reacted on cord occlusion with an increase in the... (More)
Objective. The purpose of this experimental study was to elucidate alterations in fetal energy metabolism in relation to ECG changes during extreme fetal asphyxia, postnatal resuscitation and the immediate post-resuscitatory phase. Study design. Five near-term fetal sheep were subjected to umbilical cord occlusion until cardiac arrest followed by delivery, resuscitation and postnatal pressure-controlled ventilation. Four sheep served as sham controls and were delivered immediately after ligation of the umbilical cord. Fetal ECG was analysed online for changes of the ST segment. Fetal metabolism was monitored by intracerebral and subcutaneous microdialysis catheters. Results. Fetal ECG reacted on cord occlusion with an increase in the T-wave height followed by changes in intracerebral levels of oxidative parameters. Cerebral lactate/pyruvate ratio and glutamate increased to median (range) of 240 (200-744) and 34.0 (22.6-60.5) mmol/l, respectively; both parameters returned to baseline after resuscitation. Cerebral glucose decreased to 0.1 (0.08-0.12) mmol/l after occlusion and increased above baseline upon resuscitation. In subcutaneous tissue as well as blood the increase in lactate occurred with a delay compared to cerebral levels. Conclusion. The fetal ECG changes related to asphyxia preceded the increase in excitotoxicity as determined by increase in cerebral glutamate during asphyxia. Cerebral lactate increase was superior to subcutaneous lactate increase. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Maternal-Fetal & Neonatal Medicine
volume
23
issue
2
pages
158 - 166
publisher
Taylor & Francis
external identifiers
  • wos:000274407900008
  • pmid:20074023
  • scopus:75449097763
ISSN
1476-7058
DOI
10.3109/14767050903067360
language
English
LU publication?
yes
id
12449c27-c761-4428-8009-66fa07e79d87 (old id 1541068)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/20074023?dopt=Abstract
date added to LUP
2010-02-02 13:28:32
date last changed
2018-05-29 09:52:08
@article{12449c27-c761-4428-8009-66fa07e79d87,
  abstract     = {Objective. The purpose of this experimental study was to elucidate alterations in fetal energy metabolism in relation to ECG changes during extreme fetal asphyxia, postnatal resuscitation and the immediate post-resuscitatory phase. Study design. Five near-term fetal sheep were subjected to umbilical cord occlusion until cardiac arrest followed by delivery, resuscitation and postnatal pressure-controlled ventilation. Four sheep served as sham controls and were delivered immediately after ligation of the umbilical cord. Fetal ECG was analysed online for changes of the ST segment. Fetal metabolism was monitored by intracerebral and subcutaneous microdialysis catheters. Results. Fetal ECG reacted on cord occlusion with an increase in the T-wave height followed by changes in intracerebral levels of oxidative parameters. Cerebral lactate/pyruvate ratio and glutamate increased to median (range) of 240 (200-744) and 34.0 (22.6-60.5) mmol/l, respectively; both parameters returned to baseline after resuscitation. Cerebral glucose decreased to 0.1 (0.08-0.12) mmol/l after occlusion and increased above baseline upon resuscitation. In subcutaneous tissue as well as blood the increase in lactate occurred with a delay compared to cerebral levels. Conclusion. The fetal ECG changes related to asphyxia preceded the increase in excitotoxicity as determined by increase in cerebral glutamate during asphyxia. Cerebral lactate increase was superior to subcutaneous lactate increase.},
  author       = {Amer-Wåhlin, Isis and Nord, Anders and Bottalico, Barbara and Hansson, Stefan and Ley, David and Marsal, Karel and Ungerstedt, Urban and Nordström, Carl-Henrik},
  issn         = {1476-7058},
  language     = {eng},
  number       = {2},
  pages        = {158--166},
  publisher    = {Taylor & Francis},
  series       = {Journal of Maternal-Fetal & Neonatal Medicine},
  title        = {Fetal cerebral energy metabolism and electrocardiogram during experimental umbilical cord occlusion and resuscitation.},
  url          = {http://dx.doi.org/10.3109/14767050903067360},
  volume       = {23},
  year         = {2010},
}