{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:40:13Z","timestamp":1792798813412,"version":"4.5.0"},"reference-count":36,"publisher":"BMJ","issue":"6","funder":[{"name":"Research Foundation of the Cerebral Palsy Alliance","id":[{"id":"https:\/\/ror.org\/00retz024","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Victorian Governments Operational Infrastructure Support Program","id":[{"id":"https:\/\/ror.org\/02xvc5r05","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Institute of Health"},{"DOI":"10.13039\/501100001030","name":"National Heart Foundation of Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Arch Dis Child Fetal Neonatal Ed"],"accepted":{"date-parts":[[2017,11,5]]},"published-print":{"date-parts":[[2018,11]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Physiologically based cord clamping (PBCC) has advantages over immediate cord clamping (ICC) during preterm delivery, but its efficacy in asphyxiated infants is not known. We investigated the physiology of PBCC following perinatal asphyxia in near-term lambs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Near-term sheep fetuses (139\u00b12 (SD) days\u2019 gestation) were instrumented to measure umbilical, carotid, pulmonary and femoral arterial flows and pressures. Systemic and cerebral oxygenation was recorded using pulse oximetry and near-infrared spectroscopy, respectively. Fetal asphyxia was induced until mean blood pressure reached ~20\u2009mm Hg, where lambs underwent ICC and initiation of ventilation (n=7), or ventilation for 15\u2009min prior to umbilical cord clamping (PBCC; n=8). Cardiovascular parameters were measured and white and grey matter microvascular integrity assessed using qRT-PCR and immunohistochemistry.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>PBCC restored oxygenation and cardiac output at the same rate and in a similar fashion to lambs resuscitated following ICC. However, ICC lambs had a rapid and marked overshoot in mean systemic arterial blood pressure from 1 to 10\u2009min after ventilation onset, which was largely absent in PBCC lambs. ICC lambs had increased cerebrovascular injury, as indicated by reduced expression of blood\u2013brain barrier proteins and increased cerebrovascular protein leakage in the subcortical white matter (by 86%) and grey matter (by 47%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PBCC restored cardiac output and oxygenation in an identical time frame as ICC, but greatly mitigated the postasphyxia rebound hypertension measured in ICC lambs. This likely protected the asphyxiated brain from cerebrovascular injury. PBCC may be a more suitable option for the resuscitation of the asphyxiated newborn compared with the current standard of ICC.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/archdischild-2017-313657","type":"journal-article","created":{"date-parts":[[2017,11,30]],"date-time":"2017-11-30T12:20:33Z","timestamp":1512044433000},"page":"F530-F538","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":76,"title":["Physiologically based cord clamping stabilises cardiac output and reduces cerebrovascular injury in asphyxiated near-term lambs"],"prefix":"10.1136","volume":"103","author":[{"given":"Graeme R","family":"Polglase","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":"Douglas A","family":"Blank","sequence":"additional","affiliation":[{"name":"The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha K","family":"Barton","sequence":"additional","affiliation":[{"name":"The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia"},{"name":"Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne L","family":"Miller","sequence":"additional","affiliation":[{"name":"The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia"},{"name":"Centre for Clinical Brain Sciences, The University of Edinburgh, Edinburgh, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanesa","family":"Stojanovska","sequence":"additional","affiliation":[{"name":"The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Kluckow","sequence":"additional","affiliation":[{"name":"Department of Neonatology, Royal North Shore Hospital and University of Sydney, Sydney, New South Wales, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew W","family":"Gill","sequence":"additional","affiliation":[{"name":"Centre for Neonatal Research and Education, The University of Western Australia, Subiaco, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenic","family":"LaRosa","sequence":"additional","affiliation":[{"name":"The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arjan B","family":"te Pas","sequence":"additional","affiliation":[{"name":"Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands"}],"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":[[2017,11,30]]},"reference":[{"key":"2025090511320736000_103.6.F530.1","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1159\/000320332","article-title":"Reducing global neonatal mortality is possible","volume":"99","author":"Saugstad","year":"2011","journal-title":"Neonatology"},{"key":"2025090511320736000_103.6.F530.2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000389"},{"key":"2025090511320736000_103.6.F530.3","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1016\/j.braindev.2007.05.009","article-title":"The impact of Neonatal Resuscitation Program courses on mortality and morbidity of newborn infants with perinatal asphyxia","volume":"30","author":"Duran","year":"2008","journal-title":"Brain Dev"},{"key":"2025090511320736000_103.6.F530.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)71877-8"},{"key":"2025090511320736000_103.6.F530.5","doi-asserted-by":"publisher","DOI":"10.1053\/j.semperi.2010.09.009"},{"key":"2025090511320736000_103.6.F530.6","first-page":"409","article-title":"No cry at birth: global estimates of intrapartum stillbirths and intrapartum-related neonatal deaths","volume":"83","author":"Lawn","year":"2005","journal-title":"Bull World Health Organ"},{"key":"2025090511320736000_103.6.F530.7","doi-asserted-by":"publisher","DOI":"10.1186\/1478-4505-5-4"},{"key":"2025090511320736000_103.6.F530.8","unstructured":"Matthews Z . 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