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Objective The study aimed to assess the association of nucleated red blood cells (NRBC), a surrogate of intrauterine hypoxia, and elevated pulmonic vascular resistance (E-PVR) and oxygen requirement after minimally invasive surfactant therapy (MIST). Study Design Retrospective study of a cohort of preterm neonates that received MIST in a single unit. Results NRBC were measured in 65 of 75 (87%) neonates administered MIST during the period. In total, 22 of 65 (34%) infants had pre-MIST echocardiography (ECHO). Neonates with elevated NRBC (predefined as >5 x 10 9 /L, n = 16) required higher post-MIST fraction of inspired oxygen (FiO 2) than neonates with normal NRBC (<1 x 10 9 /L, n = 17; FiO 2 = 0.31 +/- 0.10 and 0.24 +/- 0.04, respectively, p = 0.02). NRBC correlated positively with % of time in right to left ductal shunt (r = 0.51, p = 0.052) and inversely with right ventricular stroke volume (r = -0.55, p = 0.031) and time to peak velocity to right ventricular ejection time ratio (r = -0.62, p < 0.001). Conclusion Elevated NRBC are associated with elevated FiO 2 after MIST and elevated E-PVR. Intrauterine hypoxia may impact postnatal circulatory adaptations and oxygen requirement. Key Points Post-MIST FiO2 requirements are significantly higher in infants with elevated NRBC. NRBC correlates positively with elevated PVR in neonates requiring. Intrauterine hypoxia may play a role in postnatal circulatory adaptations in neonates with RDS.Copyright © 2021. Thieme. All rights reserved.

Objectives: To ascertain the impact of skin-to-skin care between parents and infants on cardiac function and cerebral blood flow in preterm infants. Study design: We undertook a prospective study of 40 self-ventilating preterm infants at a quaternary center and assessed cardiac performance and cerebral blood flow. Assessments were carried out two hours before skin-to-skin care and then 60 minutes after skin-to-skin care (with the infant still on parent and turned supine). Result(s): Infants were 30.5 +/- 0.6 weeks' gestational age and 1378 +/- 133 g birthweight. Axillary temperature noted a nonsignificant increase during skin-to-skin care from 36.7 +/- 0.07degreeC to 36.9 +/- 0.07degreeC (P =.07). Cardiac contractility (right ventricular fractional area change [26.5% +/- 0.3% vs 27.8% +/- 0.4; P <.001] and tricuspid annular plane systolic excursion [0.73 +/- 0.03 cm vs 0.77 +/- 0.03 cm; P =.02]) increased significantly, coincident with decreased measures of pulmonary vascular resistance. An increase in systemic cardiac output was associated with increased cerebral blood flow and reduced middle cerebral artery resistive index (0.81 +/- 0.02 vs 0.74 +/- 0.02; P =.0001). Conclusion(s): We documented a significant circulatory beneficial adaptation to a common neonatal practice. These findings align with previously documented physiologic benefits in cardiorespiratory stability and cardiac rhythm in preterm infants, and may be mediated through modulation of the autonomic nervous system.Copyright © 2020 Elsevier Inc.

Objectives: To ascertain the impact of skin-to-skin care between parents and infants on cardiac function and cerebral blood flow in preterm infants. Study design: We undertook a prospective study of 40 self-ventilating preterm infants at a quaternary center and assessed cardiac performance and cerebral blood flow. Assessments were carried out two hours before skin-to-skin care and then 60 minutes after skin-to-skin care (with the infant still on parent and turned supine). Result(s): Infants were 30.5 +/- 0.6 weeks' gestational age and 1378 +/- 133 g birthweight. Axillary temperature noted a nonsignificant increase during skin-to-skin care from 36.7 +/- 0.07degreeC to 36.9 +/- 0.07degreeC (P =.07). Cardiac contractility (right ventricular fractional area change [26.5% +/- 0.3% vs 27.8% +/- 0.4; P <.001] and tricuspid annular plane systolic excursion [0.73 +/- 0.03 cm vs 0.77 +/- 0.03 cm; P =.02]) increased significantly, coincident with decreased measures of pulmonary vascular resistance. An increase in systemic cardiac output was associated with increased cerebral blood flow and reduced middle cerebral artery resistive index (0.81 +/- 0.02 vs 0.74 +/- 0.02; P =.0001). Conclusion(s): We documented a significant circulatory beneficial adaptation to a common neonatal practice. These findings align with previously documented physiologic benefits in cardiorespiratory stability and cardiac rhythm in preterm infants, and may be mediated through modulation of the autonomic nervous system.Copyright © 2020 Elsevier Inc.