{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:34:56Z","timestamp":1787016896920,"version":"build-2736575974"},"reference-count":36,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child Fetal Neonatal Ed"],"accepted":{"date-parts":[[2016,3,14]]},"published-print":{"date-parts":[[2016,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>A sustained bradycardia is used as a major indicator of severe perinatal asphyxia. However, lambs asphyxiated ex utero do not exhibit the same bradycardic response as lambs asphyxiated in utero. It is possible that the local in utero environment may influence the initial cardiovascular response to asphyxia. We assessed the effect of facial immersion in water on the cardiovascular response to birth asphyxia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Pregnant ewes (138\u00b11\u2005days gestation) were anaesthetised and fetuses were exteriorised and instrumented for measurement of cardiopulmonary haemodynamics. The lamb's head either remained in air (n=5) or was placed in water that was either warm (40\u00b11\u00b0C; n=5) or at room temperature (21\u00b11\u00b0C; n=5) before the umbilical cord was clamped to induce asphyxia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Heart rate after bradycardia onset was reduced in lambs asphyxiated with their head in cool water (\u221234\u00b12%) and warm water (\u221225\u00b14%) compared with those in air (\u221211\u00b15%; p&lt;0.05). Similarly, the decrease in blood pressure was faster in lambs with water around the face compared with those in air. From 75\u2005s after asphyxia onset, mean and end-diastolic carotid blood flow was higher in the group asphyxiated in air (25\u00b14\u2005mL\/kg\/min), compared with the groups in water (13\u00b13\u2005mL\/kg\/min, warm water; 16\u00b12\u2005mL\/kg\/min, cool water; p&lt;0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The cardiovascular response to birth asphyxia is altered by the presence and temperature of water surrounding the head. The previous understanding of the vagally mediated bradycardia associated with birth asphyxia may include components of the diving reflex.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/archdischild-2015-309596","type":"journal-article","created":{"date-parts":[[2016,4,8]],"date-time":"2016-04-08T23:40:14Z","timestamp":1460158814000},"page":"F540-F545","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["The cardiovascular response to birth asphyxia is altered by the surrounding environment"],"prefix":"10.1136","volume":"101","author":[{"given":"Tracey","family":"Ong","sequence":"first","affiliation":[{"name":"The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia"},{"name":"Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristina S","family":"Sobotka","sequence":"additional","affiliation":[{"name":"The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia"},{"name":"Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa L","family":"Siew","sequence":"additional","affiliation":[{"name":"The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia"},{"name":"Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly J","family":"Crossley","sequence":"additional","affiliation":[{"name":"The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia"},{"name":"Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen J","family":"van Vonderen","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Leiden, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graeme R","family":"Polglase","sequence":"additional","affiliation":[{"name":"The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia"},{"name":"Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stuart B","family":"Hooper","sequence":"additional","affiliation":[{"name":"The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia"},{"name":"Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2016,4,8]]},"reference":[{"key":"2025090510064150000_101.6.F540.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.971127"},{"key":"2025090510064150000_101.6.F540.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.resuscitation.2010.08.018"},{"key":"2025090510064150000_101.6.F540.3","unstructured":"Dawes GS . Foetal and neonatal physiology: a comparative study of the changes at birth. Year Book Medical Publishers, 1968."},{"key":"2025090510064150000_101.6.F540.4","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1960.sp006487"},{"key":"2025090510064150000_101.6.F540.5","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1963.sp007288"},{"key":"2025090510064150000_101.6.F540.6","doi-asserted-by":"publisher","DOI":"10.1113\/jphysiol.1963.sp007248"},{"key":"2025090510064150000_101.6.F540.7","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1093\/oxfordjournals.bmb.a070442","article-title":"Resuscitation of the asphyxiated infant","volume":"22","author":"Cross","year":"1966","journal-title":"Br Med Bull"},{"key":"2025090510064150000_101.6.F540.8","first-page":"55","article-title":"The sequence of events in neonatal apnoea","volume":"2","author":"Gupta","year":"1967","journal-title":"Lancet"},{"key":"2025090510064150000_101.6.F540.9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0112264"},{"key":"2025090510064150000_101.6.F540.10","doi-asserted-by":"publisher","DOI":"10.1016\/0034-5687(69)90048-6"},{"key":"2025090510064150000_101.6.F540.11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0838.2005.00440.x"},{"key":"2025090510064150000_101.6.F540.12","first-page":"135","article-title":"Heart rate response to apnea and face immersion","volume":"22","author":"Magel","year":"1982","journal-title":"J Sports Med Phys Fitness"},{"key":"2025090510064150000_101.6.F540.13","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1152\/jappl.1967.23.6.964","article-title":"Cardiovascular effects of face immersion and factors affecting diving reflex in man","volume":"23","author":"Kawakami","year":"1967","journal-title":"J Appl Physiol"},{"issue":"Pt 1","key":"2025090510064150000_101.6.F540.14","first-page":"447","article-title":"Arterial assessment by Doppler-shift ultrasound","volume":"67","author":"Gosling","year":"1974","journal-title":"Proc R Soc Med"},{"key":"2025090510064150000_101.6.F540.15","first-page":"H668","article-title":"Oxygen delivery in lambs: cardiovascular and hematologic development","volume":"237","author":"Lister","year":"1979","journal-title":"Am J Physiol"},{"key":"2025090510064150000_101.6.F540.16","first-page":"9","article-title":"Effects of varying thermal and apneic conditions on the human diving reflex","volume":"5","author":"Speck","year":"1978","journal-title":"Undersea Biomed Res"},{"key":"2025090510064150000_101.6.F540.17","doi-asserted-by":"publisher","DOI":"10.1007\/s004210000317"},{"key":"2025090510064150000_101.6.F540.18","doi-asserted-by":"publisher","DOI":"10.1113\/expphysiol.2006.035261"},{"key":"2025090510064150000_101.6.F540.19","doi-asserted-by":"publisher","DOI":"10.1080\/08035250252833978"},{"key":"2025090510064150000_101.6.F540.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtherbio.2005.02.003"},{"key":"2025090510064150000_101.6.F540.21","first-page":"241","article-title":"Haemodynamic and catecholamine responses to hypothermia in the fetal sheep in utero","volume":"7","author":"Gunn","year":"1985","journal-title":"J Dev Physiol"},{"key":"2025090510064150000_101.6.F540.22","doi-asserted-by":"publisher","DOI":"10.1042\/cs0770581"},{"key":"2025090510064150000_101.6.F540.23","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1152\/jappl.1991.70.1.317","article-title":"Human initial responses to immersion in cold water at three temperatures and after hyperventilation","volume":"70","author":"Tipton","year":"1991","journal-title":"J Appl Physiol"},{"key":"2025090510064150000_101.6.F540.24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-7793.1999.0247z.x"},{"key":"2025090510064150000_101.6.F540.25","doi-asserted-by":"publisher","DOI":"10.1007\/BF02939035"},{"key":"2025090510064150000_101.6.F540.26","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748-1716.1988.tb08306.x"},{"key":"2025090510064150000_101.6.F540.27","doi-asserted-by":"publisher","DOI":"10.1136\/adc.2009.169102"},{"key":"2025090510064150000_101.6.F540.28","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/S0002-9378(16)32989-1","article-title":"Blood flow to fetal organs as a function of arterial oxygen content","volume":"135","author":"Peeters","year":"1979","journal-title":"Am J Obstet Gynecol"},{"key":"2025090510064150000_101.6.F540.29","first-page":"309","article-title":"Effects of reducing uterine blood flow on fetal blood flow distribution and oxygen delivery","volume":"15","author":"Jensen","year":"1991","journal-title":"J Dev Physiol"},{"key":"2025090510064150000_101.6.F540.30","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(79)90739-7"},{"key":"2025090510064150000_101.6.F540.31","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.1990.tb11551.x"},{"issue":"I","key":"2025090510064150000_101.6.F540.32","first-page":"374","article-title":"Reduced cerebral perfusion on sudden immersion in ice water: a possible cause of drowning","volume":"78","author":"Mantoni","year":"2007","journal-title":"Aviat Space Environ Med"},{"key":"2025090510064150000_101.6.F540.33","doi-asserted-by":"publisher","DOI":"10.1016\/0887-8994(91)90098-6"},{"key":"2025090510064150000_101.6.F540.34","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1242\/jeb.201.4.549","article-title":"Distribution of regional cerebral blood flow in voluntarily diving rats","volume":"201","author":"Ollenberger","year":"1998","journal-title":"J Exp Biol"},{"key":"2025090510064150000_101.6.F540.35","doi-asserted-by":"publisher","DOI":"10.1152\/japplphysiol.90370.2008"},{"key":"2025090510064150000_101.6.F540.36","doi-asserted-by":"publisher","DOI":"10.1016\/S0361-9230(03)00065-0"}],"container-title":["Archives of Disease in Childhood - Fetal and Neonatal Edition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/archdischild-2015-309596","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,5]],"date-time":"2025-09-05T17:08:15Z","timestamp":1757092095000},"score":1,"resource":{"primary":{"URL":"https:\/\/fn.bmj.com\/lookup\/doi\/10.1136\/archdischild-2015-309596"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,4,8]]},"references-count":36,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2016,10,19]]},"published-print":{"date-parts":[[2016,11]]}},"alternative-id":["10.1136\/archdischild-2015-309596"],"URL":"https:\/\/doi.org\/10.1136\/archdischild-2015-309596","relation":{},"ISSN":["1359-2998","1468-2052"],"issn-type":[{"value":"1359-2998","type":"print"},{"value":"1468-2052","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,4,8]]}}}