Fetal cerebral energy metabolism and electrocardiogram during experimental umbilical cord occlusion and resuscitation

Abstract

Objective. The purpose of this experimental study was to elucidate alterations in fetal energy metabolism in relation to ECG changes during extreme fetal asphyxia, postnatal resuscitation and the immediate post-resuscitatory phase.

Study design. Five near-term fetal sheep were subjected to umbilical cord occlusion until cardiac arrest followed by delivery, resuscitation and postnatal pressure-controlled ventilation. Four sheep served as sham controls and were delivered immediately after ligation of the umbilical cord. Fetal ECG was analysed online for changes of the ST segment. Fetal metabolism was monitored by intracerebral and subcutaneous microdialysis catheters.

Results. Fetal ECG reacted on cord occlusion with an increase in the T-wave height followed by changes in intracerebral levels of oxidative parameters. Cerebral lactate/pyruvate ratio and glutamate increased to median (range) of 240 (200–744) and 34.0 (22.6–60.5) mmol/l, respectively; both parameters returned to baseline after resuscitation. Cerebral glucose decreased to 0.1 (0.08–0.12) mmol/l after occlusion and increased above baseline upon resuscitation. In subcutaneous tissue as well as blood the increase in lactate occurred with a delay compared to cerebral levels.

Conclusion. The fetal ECG changes related to asphyxia preceded the increase in excitotoxicity as determined by increase in cerebral glutamate during asphyxia. Cerebral lactate increase was superior to subcutaneous lactate increase.

Keywords:

• Fetal ECG
• cerebral metabolism
• microdialysis

Acknowledgements

This work was funded by the Swedish Medical research Council (Grant N:o 5980) and by Grants to Researchers in the Public Health Service from the Swedish Government. The authors thank Ingela Mattisson-Sandström, Ulla Ganestam, Ann-Catrin Berg, and Katarina Nielsen for valuable technical assistance, KG Rosén for technical assistance and valuable input throughout the experiments, and Ingemar Kjellmer for valuable discussions while preparing and concluding our work. Neoventa Medical AB is acknowledged for the loan of the STAN monitor.