Cardio-Circulatory Support of Neonatal Transition

Immediate transition from fetal to extrauterine life causes complex physiological processes affecting all vital organ systems including the cardio-circulatory system. In the fetus, pulmonary vascular resistance is high and the majority of right ventricular output bypasses the lungs through the ductus arteriosus into the systemic circulation. Following the elimination of the low-resistance placenta by clamping the umbilical cord and the reduction of pulmonary vascular resistance with the first breaths after birth, major hemodynamic changes occur within transition from fetal to neonatal circulation. Pulmonary vascular resistance drops, systemic vascular resistance (SVR) increases, systemic blood flow is directed to the lungs, and within minutes to hours ductal shunt reverses from right-to-left to left-to-right, with complete physiologic closure of the ductus arteriosus within 48–72 hours after birth in healthy term infants.

Besides clinical assessment and routine monitoring with pulse-oximetry and/or electrocardiography, additional cardio-circulatory assessment may offer further insights in cardiovascular transition. Ideally, this assessment should be non-invasive and provide reliable information continuously, and should help identify neonates in need of cardio-circulatory support to guide further hemodynamic management during the immediate neonatal transition. Once (premature and full-term) neonates in need of cardio-circulatory support are identified, procedures including establishment of vascular access and emergent drug administration (e.g. to treat or avoid arterial hypotension during neonatal transition) are essential. In case of cardio-circulatory resuscitation, cardio-circulatory interventions including chest compressions are vital. Successful resuscitation and stabilization after birth in the delivery room has the potential to reduce mortality and morbidities, while suboptimal care could cause long-term sequelae. The goal of this Frontiers Research Topic is to highlight work that focuses on cardio-circulatory aspects of neonatal transition providing new insights and emerging concepts to improve hemodynamic management in neonates immediately after birth.

We welcome Original Research, Clinical Trials, Case Reports, and Systematic Reviews covering, but not limited to, the following topics:

· Advances in cardio-circulatory monitoring during neonatal transition

· (Non-)invasive monitoring of macro-circulation (e.g. cardiac output, heart rate, blood pressure, etc.)

· (Non-)invasive monitoring of (micro-)circulation (e.g. blood flow, tissue blood volume, etc.)

· Vascular access and emergency drug administration during stabilization and resuscitation of the neonate

· Chest compressions and cardio-circulatory interventions during neonatal resuscitation

· Emerging concepts in neonatal resuscitation

· Timing of umbilical cord clamping and hemodynamic effects of the different concepts

· Disorders of cardiac rhythm and function during neonatal transition

· Simulation-based research aiming improvement of neonatal cardio-circulatory stabilization.

Senior investigators are welcome to invite mentees and colleagues to co-author submissions under their supervision.