Journal of Non Invasive Vascular Investigation Category: Clinical Type: Short Commentary
Point on Early Neonatal Cardiovascular Changes and Hematocrit: Something to Study Further
- Domenico Antonio Agostino1*, Raphaël Thomasset2, Ambrogio Di Paolo3
- 1 High Specialized Unit Of Pediatric Cardiology Complex Operative Unit Of Neonatology And Nicu, San Giovanni Addolorata Hospital, Rome, Italy
- 2 Section Of Gynecology And Obstetrics, Academic Department Of Biomedicine & Prevention And Clinical Department Of Surgery, Tor Vergata University Hospital, Rome, Italy
- 3 Complex Operative Unit Of Neonatology And Nicu, San Giovanni Addolorata Hospital, Rome, Italy
*Corresponding Author:Domenico Antonio Agostino
High Specialized Unit Of Pediatric Cardiology Complex Operative Unit Of Neonatology And Nicu, San Giovanni Addolorata Hospital, Rome, Italy
Received Date: Sep 17, 2019 Accepted Date: Sep 18, 2019 Published Date: Sep 25, 2019
Where η is the viscosity, d the diameter of tube, r the radius of tube, R the resistance? Due to the small number of studies evaluating the impact of hematocrit on hydraulic resistance, in the different districts of circulation, until now we don’t know the true weight of this parameter. The main districts in which more studies are needed are: cerebral, renal, cardiac, intestinal, pulmonary, and peripheral tissue/microcirculation.
Different studies found a reduction in resistance parameters such as RI (Resistance Index) in cerebral circulation (middle cerebral artery or anterior cerebral artery) during the first hours of life but rarely the correlation is analyzed with hematocrit reduction, typically marked in this postnatal period [3-5]. The renal circulation has a significative change during these hours too: is well assessed that there is a initial slow reduction of RI and augmentation of peak systolic velocity in renal arteries during the first days and than a more rapid change in these perfusion indexes . The measurement of cardiac parameters during the transitional period let us to understand both the pulmonary and systemic circulation changes. Studies evidenced a better left cardiac function and a reduction of right ventricular pressure seen indirectly by significative change of pulmonary mean acceleration, pulmonary acceleration time and other parameters [2,3,6]. Another hot topic is the patent ductus arteriosus in very preterm newborns and the influence of hematocrit on it, a rise in hematocrit may have a positive influence causing a reduction of left-to right shunt derived from a different pressure gradient between systemic and pulmonary circulation. If this mechanism is demonstrated by large studies, could be useful especially in very preterm newborns in which the immature left ventricle is not able to support such high blood flow coming from the patent ductus arteriosus . A big open window that still needs to be studied in newborn physiology is the change of viscosity/hematocrit in peripheral tissues and microcirculation. Starting from large to capillary vessels in case of a Newtonian fluid there is no change in viscosity and so the Hagen-Poiseuille’s law is valid, but in vivo circulation there is another phenomenon that happens. The Fåhraeus-Lindqvist effect is a progressive decline in apparent viscosity when blood flows through glass capillary tubes of diminishing radius. This effect is mainly effective in the arteriolar segments of the systemic vascular tree, where the majority of the total peripheral resistance resides and is actively regulated. Thus, the Fåhraeus-Lindqvist effect has been suggested to be an evolutionary trait that alleviates the impact of arteriolar vasoconstriction upon total peripheral resistance and thereby maintain local tissue perfusion at a relatively lower blood pressure .
- Sisson TRC, Lund CJ, Whalen LE, Telek A (1959) The blood volume of infants: I. The full-term infant in the first year of life. J Pediatr 55: 163-179.
- Agostino DA, Thomasset R, Suzuki K, Versacci P, Guaglianone G, et al. (2019) Hematocrit?: another important factor in systemic neonatal cardiovascular adaptation. J Pediatr Neonatal Individ Med 8: 1-9.
- Noori S, Wlodaver A, Gottipati V, McCoy M, Schultz D, et al. (2012) Transitional changes in cardiac and cerebral hemodynamics in term neonates at birth. J Pediatr 160: 943-948.
- Forster DE, Koumoundouros E, Saxton V, Fedai G, Holberton J (2018) Cerebral blood flow velocities and cerebrovascular resistance in normal-term neonates in the first 72 hours. J Paediatr Child Health 54: 61-68.
- Ilves P, Lintrop M, Talvik I, Muug K, Asser K, et al. (2008) Developmental Changes in Cerebral and Visceral Blood Flow Velocity in Healthy Neonates and Infants. J Ultrasound Med 27: 199-207.
- Evans NJ, Archer LN (1990) Postnatal circulatory adaptation in healthy term and preterm neonates. Arch Dis Child 65: 24-26.
- Lister G, Hellenbrand WE, Kleinman CS, Talner NS (1982) Physiologic Effects of Increasing Hemoglobin Concentration in Left-to-Right Shunting in Infants with Ventricular Septal Defects. N Engl J Med 306: 502-506.
- Toksvang LN, Berg RM (2013) Using a classic paper by Robin Fåhraeus and Torsten Lindqvist to teach basic hemorheology. Adv Physiol Educ 37: 129-133.
Citation:Agostino DA, Thomasset R, Paolo AD (2019) Point on Early Neonatal Cardiovascular Changes and Hematocrit: Something to Study Further. J Non Invasive Vasc Invest 4: 016.
Copyright: © 2019 Domenico Antonio Agostino, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.