{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T05:12:05Z","timestamp":1772601125460,"version":"3.50.1"},"reference-count":43,"publisher":"American Physiological Society","issue":"2","funder":[{"DOI":"10.13039\/501100000925","name":"Department of Health, Australian Government | National Health and Medical Research Council","doi-asserted-by":"publisher","award":["1105137"],"award-info":[{"award-number":["1105137"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001030","name":"National Heart Foundation of Australia","doi-asserted-by":"publisher","award":["G12M6372"],"award-info":[{"award-number":["G12M6372"]}],"id":[{"id":"10.13039\/501100001030","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Victorian Government Operational Infrastructure Support Program"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Applied Physiology"],"published-print":{"date-parts":[[2020,2,1]]},"abstract":"<jats:p>Reversal of shunting across the ductus arteriosus from right-to-left to left-to-right is a characteristic feature of the birth transition. Given that immediate cord clamping (ICC) followed by an asphyxial cord clamp-to-ventilation (CC-V) interval may augment left ventricular (LV) output and central blood flows after birth, we tested the hypothesis that an asphyxial CC-V interval accelerates the onset of postnatal left-to-right ductal shunting. High-fidelity central blood flow signals were obtained in anesthetized preterm lambs (gestation 128\u2009\u00b1\u20092 days) after ICC followed by a nonasphyxial (\u223c40 s, n = 9) or asphyxial (\u223c90 s, n = 9) CC-V interval before mechanical ventilation for 30 min after birth. Left-to-right ductal flow segments were related to aortic isthmus and descending aortic flow profiles to quantify sources of ductal shunting. In the nonasphyxial group, phasic left-to-right ductal shunting was initially minor after birth, but then rose progressively to 437\u2009\u00b1\u2009164 ml\/min by 15 min ( P &lt; 0.001). However, in the asphyxial group, this shunting increased from 24\u2009\u00b1\u200921 to 199\u2009\u00b1\u200993 ml\/min by 15 s after birth ( P &lt; 0.001) and rose further to 471\u2009\u00b1\u2009190 ml\/min by 2 min ( P &lt; 0.001). This earlier onset of left-to-right ductal shunting was supported by larger contributions ( P &lt; 0.001) from direct systolic LV flow and retrograde diastolic discharge from an arterial reservoir\/windkessel located in the descending aorta and its major branches, and associated with increased pulmonary arterial blood flow having a larger ductal component. These findings suggest that the duration of the CC-V interval after ICC is an important modulator of left-to-right ductal shunting, LV output and pulmonary perfusion at birth.<\/jats:p><jats:p>NEW &amp; NOTEWORTHY This birth transition study in preterm lambs demonstrated that a brief (\u223c90 s) asphyxial interval between umbilical cord clamping and ventilation onset resulted in earlier and greater left-to-right shunting across the ductus arteriosus after birth. This greater shunting 1) resulted from an increased left ventricular output associated with a higher systolic left-to-right ductal flow and increased retrograde diastolic discharge from a lower body arterial reservoir\/windkessel, and 2) was accompanied by greater lung perfusion after birth.<\/jats:p>","DOI":"10.1152\/japplphysiol.00559.2019","type":"journal-article","created":{"date-parts":[[2020,1,23]],"date-time":"2020-01-23T16:43:56Z","timestamp":1579797836000},"page":"429-439","source":"Crossref","is-referenced-by-count":9,"title":["Brief asphyxial state following immediate cord clamping accelerates onset of left-to-right shunting across the ductus arteriosus after birth in preterm lambs"],"prefix":"10.1152","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7363-0172","authenticated-orcid":false,"given":"Joseph J.","family":"Smolich","sequence":"first","affiliation":[{"name":"Heart Research, Murdoch Children\u2019s Research Institute, Melbourne, Australia"},{"name":"Department of Paediatrics, University of Melbourne, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly R.","family":"Kenna","sequence":"additional","affiliation":[{"name":"Heart Research, Murdoch Children\u2019s Research Institute, Melbourne, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael M. 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