Biology subjects

Polglase, G. R.

Publications and source records attributed to Polglase, G. R..

2 recordsLinked to original sources

bioRxiv2025

Perinatal Asphyxia Alters Physiological Responses and Ex Vivo Cardiovascular Function of Preterm Growth-Restricted Lambs

IntroductionFetal growth restriction (FGR) arises from chronic hypoxia and increases the risk of cardiovascular dysfunction following perinatal asphyxia, although the underlying mechanisms are unknown. We investigated whether FGR lambs have altered cardiovascular responses to perinatal asphyxia compared to control lambs, and whether impairments in 1 and {beta}1 adrenergic receptor function underlie these responses. MethodsSingle or twin-bearing ewes underwent sterile fetal surgery at 89 days gestation (dGA; term=148d) to induce FGR (single umbilical artery ligation) or sham surgery (Control). At 126dGA, lambs were delivered via caesarean section, instrumented and randomised to immediate ventilation (ControlVENT n=6; FGRVENT n=6), or asphyxia (ControlASPHYXIA n=12; FGRASPHYXIA n=11) induced by umbilical cord occlusion while withholding resuscitation until diastolic blood pressure (BP) decreased to 10mmHg. Lambs were ventilated for 8 hours before baseline ex vivo cardiac function was assessed via Langendorff perfusion to measure left ventricular developed pressure (LVDP), heart rate (HR) and coronary perfusion pressure (CPP). Ex vivo 1 and {beta}1 adrenergic responses were assessed via phenylephrine (10-5 to 10-2 mmol/L) and dobutamine (10-7 to 10-4) administration, respectively. ResultsFGRASPHYXIA lambs had lower BP during asphyxia (p<0.05 vs ControlASPHYXIA) and took longer to reach a diastolic BP of 10mmHg (14.5 {+/-} 0.8 min vs. 19.2 {+/-} 1.3 min; p=0.005). FGRASPHYXIA lambs had lower BP in the first 5 minutes after return of spontaneous circulation (p<0.05) due to impaired vascular contractility, with reduced Tau, dP/dtmax and dP/dtmin (p<0.03 vs ControlASPHYXIA). Baseline LVDP, HR and CPP were similar between groups, however FGRASPHYXIA lambs had increased LVDP responses to phenylephrine and dobutamine (p<0.05 vs ControlASPHYXIA), without significant changes to HR or CPP. ConclusionFGR lambs have altered physiological responses to perinatal asphyxia due to impaired vascular contractility and dysregulated cardiac 1 and {beta}1 adrenergic receptor function, which may increase susceptibility to cardiovascular dysfunction in the neonatal period.

physiology↗

bioRxiv2023

Evaluating The Efficacy Of Endotracheal Epinephrine Administration At Standard Versus High Dose During Resuscitation Of Severely Asphyxiated Newborn Lambs: A Randomized Preclinical Study

BackgroundEpinephrine treatment is recommended during neonatal resuscitation, if ventilation and chest compressions are ineffective. Endotracheal administration is an option, if the preferred intravenous route is unavailable. We aimed to determine the efficacy of endotracheal epinephrine for achieving return of spontaneous circulation (ROSC), and maintaining physiological stability after ROSC, at standard and higher dose, in severely asphyxiated newborn lambs. MethodsNear-term fetal lambs were instrumented for physiological monitoring, and asphyxiated until asystole. Resuscitation was commenced with ventilation and chest compressions as per ILCOR recommendations. Lambs were randomly allocated to: IV Saline placebo (5 ml/kg, n=6), IV Epinephrine (20 micrograms/kg, n=9), Standard-dose ET Epinephrine (100 micrograms/kg, n=9), and High-dose ET Epinephrine (1 mg/kg, n=9). After three allocated treatment doses, rescue IV Epinephrine was administered if ROSC had not occurred. Lambs achieving ROSC were ventilated and monitored for 60 minutes before euthanasia. Brain histology was assessed for micro-hemorrhage. ResultsROSC in response to allocated treatment (without rescue IV Epinephrine) occurred in 1/6 Saline, 9/9 IV Epinephrine, 0/9 Standard-dose ET Epinephrine, and 7/9 High-dose ET Epinephrine lambs respectively. Three Saline, six Standard-dose ET Epinephrine, and one High-dose ET Epinephrine lambs achieved ROSC after rescue IV Epinephrine. Blood pressure during CPR increased after treatment with IV Epinephrine and High-dose ET Epinephrine, but not Saline or Standard-dose ET Epinephrine. After ROSC, both ET Epinephrine groups had lower pH, higher lactate, and higher blood pressure than the IV Epinephrine group. Cortex micro-hemorrhage was more frequent in the High-dose ET Epinephrine lambs (8/8 lambs examined, versus 3/8 in IV Epinephrine lambs). ConclusionsThe currently recommended dose of ET Epinephrine was ineffective in achieving ROSC. In the absence of convincing clinical or preclinical evidence of efficacy, use of ET Epinephrine at this dose may not be appropriate. High-dose ET Epinephrine requires further evaluation before clinical translation.

physiology↗