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<p>Respiratory distress syndrome is a major cause of mortality among pre-term and term neonatal population. To overcome the limitations of current therapies, a new form of respiratory support termed the, “Artificial Placenta” has been proposed. The Artificial Placenta is a type of oxygenator that is attached postnatally via the umbilical vessels to provide pumpless respiratory support to pre-term and term neonates. To develop this concept, our group previously reported on a novel polycarbonate membrane lung assist device (LAD). To build upon its development, the objectives of this thesis are to determine the optimal interface for gas exchange, and characterize the gas exchange properties of the LAD under ambient and oxygen rich atmosphere. Subsequently, its feasibility was determined by studying the effects of extracorporeal flow rates on cardiovascular parameters and gas exchange performance was assessed in a newborn piglet model.</p> <p>In vitro testing demonstrated that PDMS based membrane is the optimal interface for gas exchange in the LAD. In vitro testing of the LAD demonstrated 2.4 µL/min/cm² -3.8 µL/min/cm² and 6.4 µL/min/cm²- 10.1 µL/min/cm² of O₂ and CO₂ transfer respectively under ambient air and oxygen rich atmospheric conditions. Based on these results, the LAD theoretically could provide 6-11% of metabolic O₂ while eliminating 18-26% of CO₂in a newborn healthy pre term infant. Experiments in newborn piglet models achieved pumpless configuration with flow rates up to 60.9ml/kg/min without presenting decompensation. Preliminary, in vivo gas exchange experiments demonstrated O₂ transfer of 3ul/min/cm², which matches closely to in vitro data.</p> <p>A novel pumpless LAD is reported, which provides sufficient respiratory support. High extracorporeal flow rates with stable cardiovascular parameters demonstrate feasibility of the artificial placenta concept. This novel LAD could potentially serve as a rescue device when all other therapies such as nasal continuous positive airway and mechanical ventilation fail.</p> / Master of Applied Science (MASc)

Background: Folate and vitamin B12 have interdependent metabolic functions that are essential for neonate growth outcomes (i.e. birth weight) based on studies from India. The objective of this research was to evaluate the association of maternal folate and vitamin B12 concentrations with neonate birth weight in South Asian (SA) and white European (WE) populations. Methods: In this cross-sectional analysis of prospective cohort studies, maternal and neonatal data were collected during the second trimester from 3758 mother-child dyads living in Canada. Maternal diet and supplement use were assessed using a validated food frequency questionnaire. Biochemical indicators were analyzed in a subset of SA mothers. Birth weight was measured within 72 hours of delivery. All regression analyses were performed unadjusted and with adjustment for identified covariates. Results: Maternal folate and vitamin B12 (dietary, supplemental and total) were not associated with neonate birth weight in SA and WE pregnant women. Higher consumption of milk products by SA women was associated with higher birth weight (β=0.06; p=0.01), whereas higher consumption of egg by WE women was associated with lower birth weight (β=-0.19; p<0.01). Folate and vitamin B12 deficiency in the SA subgroup was 13.7% and 17.8%, respectively. Maternal serum vitamin B12 status was inversely associated with birth weight (β=-0.16; p=0.03). Conclusions: Folate and vitamin B12 may be proxies for poor nutritional status. Therefore, folate and vitamin B12 may have an association with neonate birth weight in a less developed area (i.e. India) rather than in a highly developed area (i.e. Canada). Highly developed countries have an adequate intake of folate and vitamin B12 and thus a higher nutritional baseline status. These findings complement current research on folate and vitamin B12 concentrations with birth weight in well-nourished populations. / Thesis / Master of Science (MSc) / Infant birth weight is an indicator of health and disease risk in adult life. The mother’s vitamin intake can influence the weight of the infant. This research aimed to study whether the mother’s folate and vitamin B12 status is related to infant birth weight. Dietary and supplemental data along with blood samples from South Asian and white European pregnant women living in Canada were collected during the second trimester. The mother’s dietary, supplemental and total folate and vitamin B12 intakes were not related to infant birth weight. In South Asian mothers, higher milk intake was related to higher birth weight and in white Europeans, higher egg intake was related to lower infant birth weight. Higher vitamin B12 in the blood was related to lower infant birth weight in South Asians. More research is needed to determine the relationship between folate and vitamin B12 with infant birth weight.

The neonatal period in mammals is characterized by high growth rates and is dominated by skeletal muscle hypertrophy. Low birth weight (LBWT) neonates experience restricted growth and development of skeletal muscle, leading to metabolic perturbations later in life. The overall hypothesis of this dissertation was that in utero disturbances in glucose metabolism and increased energy requirements predisposes LBWT neonatal pigs to metabolic disturbances after birth. We sought to increase growth of skeletal muscle and improve glucose production through increasing dietary energy and to determine the changes in glucose catabolism and metabolic flexibility in different skeletal muscle fiber types in LBWT neonates. Piglets were considered normal birth weight (NBWT) and LBWT when birth weight was within 0.5 SD and below 2 SD of the litter average, respectively. Increasing dietary energy increased lean deposition in the longissimus dorsi (LD) in both NBWT and LBWT neonates. Although glucose rate of appearance was greater in LBWT compared to their NBWT sibling, glucose concentrations were reduced in LBWT compared to NBWT pigs, regardless of diet fed. Postprandial glucose concentrations were lower in LBWT compared to NBWT pigs, regardless of diet fed, although rate of appearance did not differ between them. This would suggest that glucose is being absorbed in the peripheral tissues to be utilized. However, expression of enzymes related to glycolysis were downregulated in both the soleus and LD of LBWT compared to NBWT neonatal pigs. In addition, expression of enzymes related to the catabolism of glucose in the serine biosynthetic pathway were decreased in both the soleus and LD muscles of LBWT compared to NBWT neonatal pigs. Expression of the pentose phosphate pathway was slightly increased in LBWT compared to NBWT siblings in both muscle types. Increased expression of pyruvate dehydrogenase 4 was exhibited in both the soleus and LD of LBWT pigs compared to NBWT siblings. This would indicate a switch in fuel utilization to more fatty acid oxidation. By contrast, CO2 production from the oxidation of palmitate was reduced in LBWT compared with NBWT pigs along with reduced oxidation of glucose and pyruvate. In conclusion, lipid supplementation increased growth at the expense of fat deposition in the liver of NBWT and LBWT pigs. However, supplementing with fat did not increase glucose production due to the contribution of glycerol remaining constant. Hypoglycemia cannot be attributed to greater catabolism in skeletal muscle due to decreased expression of glycolytic genes and the addition of fatty acids did not spare glucose oxidation in skeletal muscle of LBWT pigs. / PHD / During the neonatal period animals display the fastest growth rates, especially pertaining to muscle growth. Muscle development in low birth weight (LBWT) is restricted, leading not only to impaired postnatal growth but increases the risk for developing metabolic diseases later in life such as obesity and type 2 diabetes. LBWT is also characterized by decreased glucose concentrations and decreased body fat content at birth. In the present studies we sought to increase growth and improve glucose production by supplementing with a high energy diet and to compare the changes in glucose catabolism in different skeletal muscle fiber types along with analyzing the ability to switch fuel substrates in LBWT and NBWT neonatal pigs. Increasing dietary energy increased longissimus dorsi (LD) weight as a percentage of bodyweight, regardless of growth status. In addition, during fasting glucose production was higher in LBWT compared to their NBWT siblings, regardless of diet. However, glucose concentration in LBWT were lower compared to NBWT neonatal pigs. Although glucose concentrations were lower in LBWT compared to NBWT pigs after a meal, glucose production rate was unchanged among LBWT and NBWT siblings fed either a high or low energy diet. This suggests that glucose uptake is increased in peripheral tissues of LBWT pigs. However, enzymes related to glycolysis in the LD and soleus of LBWT pigs had lower expression than their NBWT sibling. In addition, the enzyme responsible for the shift in fuel selection, pyruvate dehydrogenase kinase 4 (PDK4) was highly expressed in LBWT compared to NBWT neonatal pigs in both the LD and soleus. This would suggest a switch in glucose oxidation to fatty acid oxidation in the skeletal muscle of LBWT neonatal pigs. However, oxidation of fatty acids in both the soleus and LD of LBWT was reduced compared to NBWT neonatal pigs. In conclusion, lipid supplementation increased growth at the expense of lipid deposition in the liver and did not increase glucose production. Reduced glucose concentrations are not due to greater catabolism in skeletal muscle due to decreased expression of glycolytic genes and the addition of fatty acids did not spare glucose oxidation in the skeletal muscle of LBWT pigs.

Horses that are exposed to Sarcocystis neurona, a causative agent of equine protozoal myeloencephalitis, produce antibodies that are detectable in serum by western blot (WB). A positive test is indicative of exposure to the organism. Positive tests in young horses can be complicated by the presence of maternal antibodies. Passive transfer of maternal antibodies to S. neurona from seropositive mares to their foals was evaluated. Foals were sampled at birth (presuckle), at 24 hours of age (postsuckle), and at monthly intervals. All foals sampled before suckling were seronegative. Thirty-three foals from 33 seropositive mares became seropositive with colostrum ingestion at 24 hours of age, confirming that passive transfer of S. neurona maternal antibodies occurs. Thirty-one of the 33 foals became seronegative by 9 months of age, with a mean seronegative conversion time of 4.2 months. These results indicate that evaluation of exposure to S. neurona by WB analysis of serum may be misleading in young horses. Cerebrospinal fluid (CSF) samples from 15 neonatal (2-8 day) foals were examined for the presence of antibodies to S. neurona by WB analysis. Twelve of 13 foals that were seropositive were also CSF positive, suggesting that maternal antibodies to S. neurona cross the blood-CSF barrier in neonatal foals resulting in a positive CSF WB. Repeat taps were performed on 5 of the foals which showed that the immunoreactivity of the western blot decreases over time. Two of the 5 foals were CSF negative at 83 and 84 days of age, with 1 foal still positive at 90 days, and 2 foals positive at 62 days. These results indicate that maternal antibodies to S. neurona in the CSF can confound WB results in neonatal foals up to several months of age. / Master of Science

INTRODUÇÃO: A encefalopatia hipóxico-isquêmica (EHI) corresponde a uma das maiores causas de morbidade e mortalidade neonatal. Ocorre em consequência à asfixia perinatal aguda, representada por baixo escore de Apgar e evidências de distúrbios neurológicos ao nascimento. A hipotermia terapêutica (HT) tem mostrado benefícios relevantes no prognóstico neurológico a longo prazo, por reduzir o metabolismo cerebral, retardando o início da despolarização hipóxica celular. Os efeitos da HT no sistema cardiovascular foram pouco estudados, suscitando questionamentos quanto à adequada interpretação dos achados ecocardiográficos nesta condição terapêutica. OBJETIVO: avaliar o comportamento hemodinâmico e da função ventricular de recém-nascidos com EHI na vigência de HT, utilizando-se técnicas ecocardiográficas convencionais e avançadas. MÉTODO: trata-se de um estudo observacional desenvolvido em três instituições, em que 22 recém-nascidos com EHI foram avaliados por meio da ecocardiografia nas duas fases da HT (durante a hipotermia e após o reaquecimento). O grupo controle foi composto por 22 recém-nascidos saudáveis. Os bebês foram submetidos a HT seguindo critérios do protocolo de hipotermia de cada um dos serviços. RESULTADOS: Função ventricular esquerda: as frações de ejeção (FE) e de encurtamento foram maiores após o reaquecimento (74 ± 5% e 41 ± 5% respectivamente) em relação ao grupo controle (70 ± 5%, p = 0,003 e 37 ± 4%, p = 0,002). O índice de performance miocárdica (IPM) do ventrículo esquerdo (VE) avaliado pelo Doppler pulsado se manteve constante nas duas fases da HT (0,51 ± 0,13, hipotermia = reaquecimento) e foi menor na comparação destas com o grupo controle (0,63 ± 0,18, p = 0,02). Os valores do strain circunferencial e radial, do twist, da torção e do strain longitudinal global do VE (STLGLVE) foram semelhantes entre o grupo controle e o grupo estudo, tanto durante a hipotermia quanto após o reaquecimento. Função ventricular direita: Observou-se incremento da velocidade da onda s´ do ventrículo direito (VD) após o reaquecimento (de 0,07 ± 0,02 m/s durante a hipotermia para 0,09 ± 0,01 m/s, p < 0,001), sendo esta também mais elevada quando comparada aos valores do grupo controle (0,07 ± 0,01 m/s, p < 0,001). Houve queda dos valores da variação fracional das áreas (FAC) do VD após o reaquecimento (38 ± 11% durante a hipotermia, 36 ± 11% após o reaquecimento e 43 ± 10% grupo controle), com diferenças significativas entre esses dois últimos (p = 0,03). Quanto ao IPM do VD, o grupo controle apresentou médias menores (0,29 ± 0,13) que o grupo caso durante a hipotermia (0,46 ± 0,33, p = 0,03). O strain longitudinal global do VD (STLGLVD) foi significativamente pior tanto durante a hipotermia (-18 ± -5%, p = 0,02) quanto após o reaquecimento (-18 ± 4%, p = 0,01) quando comparados ao grupo controle (-21 ± 2%). Parâmetros hemodinâmicos: A pressão sistólica na artéria pulmonar foi mais elevada no grupo estudo durante as duas fases do tratamento (hipotermia 45 ± 24 mmHg, p = 0,02 e reaquecimento 53 ± 34 mmHg, p = 0,01 versus grupo controle 29 ± 11 mmHg). A FC foi significativamente mais baixa durante a hipotermia comparada ao período após o reaquecimento (FC 111 ± 19 bpm versus 144 ± 20 bpm, p < 0,001) e ao grupo controle (FC 130 ± 16 bpm, p < 0,001). Durante o reaquecimento, observou-se elevação do débito cardíaco (DC) esquerdo e direito em relação ao período de hipotermia (DC esquerdo 214 ± 39 ml/kg/min versus 155 ± 47 ml/kg/min, p < 0,001; DC direito 369 ± 141 ml/kg/min versus 269 ± 113 ml/Kg/min, p = 0,005) sendo significativamente mais elevado que no grupo controle (DC Esquerdo 174 ± 47 ml/kg/min, p = 0,004 e DC direito 288 ± 74 ml/Kg/min, p = 0,02). CONCLUSÕES: A função ventricular esquerda permanece estável nas duas fases da HT, demonstrando o baixo comprometimento cardíaco esquerdo do resfriamento induzido. Os valores da FE, da fração de encurtamento e da onda s´ do VD, maiores após o reaquecimento, podem ser consequentes a um estado hiperdinâmico do coração. Disfunção ventricular direita foi observada nos momentos em que a pressão pulmonar estava elevada. O STLGLVD foi a única ferramenta capaz de identificar o comprometimento da função sistólica do VD durante a HT. / INTRODUCTION: The hypoxic-ischemic encephalopathy (HIE) corresponds to one of the biggest causes of neonatal morbidity and mortality. It occurs in consequence to acute perinatal asphyxia, represented by low Apgar score and evidences of neurological disorders in birth. The therapeutic hypothermia (TH) has shown significant benefits in long term neurological prognosis, by reducing the cerebral metabolism, delaying the onset of the hypoxic depolarization in cellular level. The TH effects in cardiovascular system have been insufficiently researched, raising questions regarding the adequate reading of the echocardiographic results in this condition. OBJECTIVE: to evaluate the hemodynamic and the ventricular performance of neonates with HIE submitted to TH, using conventional and advanced echocardiographic techniques. METHODS: this research is an observational study developed in three institutions, in which 22 neonates with HIE were evaluated by echocardiography in the two phases of TH (during hypothermia and after rewarming). The control group was composed by 22 healthy neonates. The infants were submitted to TH following hypothermia protocol criteria of each services. RESULTS: Left ventricular function: the ejection fraction (EF) and the shortening fraction were higher after rewarming (74 ± 5% and 41 ± 5% respectively) compared to the control group (70 ± 5%, p = 0.003 and 37 ± 4%, p = 0.002). The myocardial performance index (MPI) of the left ventricle (LV), evaluated by pulsed wave Doppler, remained constant in the two phases of TH (0.51 ± 0.13, hypothermia = rewarming) and this MPI was lower in comparison to the control group (0.63 ± 0.18, p = 0.02). The values of the circumferential and radial strain, the twist, the torsion and the global longitudinal strain (GLS) of the LV were similar between the control group and the study group, as during hypothermia as after rewarming. Right ventricular function: it was noted increment of the right ventricle (RV) s´ wave velocity after rewarming (from 0.07 ± 0.02 m/s during hypothermia to 0.09 ± 0.01 m/s, p < 0.001), also it was higher when compared to the control group (0.07 ± 0.01 m/s, p < 0.001). There was decrease of the RV fractional area change (FAC) values after rewarming (38 ± 11% during hypothermia, 36 ± 11% after rewarming and 43 ± 10% in control group), with significant differences between these two last values (p = 0.03). Regarding RV\'s MPI, the control group presented lower averages (0.29 ± 0.13) than the case group during hypothermia (0.46 ± 0.33, p = 0.03). The RV GLS was worse as during hypothermia (-18 ± -5%, p = 0.02) as after rewarming (-18 ± 4%, p = 0.01) when compared to the control group (-21 ± 2%). Hemodynamic parameters: The pulmonary artery systolic pressure was higher in the study group during the two phases of the treatment (hypothermia 45 ± 24 mmHg, p = 0.02 and rewarming 53 ± 34 mmHg, p = 0.01 versus control group 29 ± 11 mmHg). The heart rate (HR) was significantly lower during hypothermia compared to the after rewarming period (HR 111 ± 19 bpm versus 144 ± 20 bpm, p < 0.001) and to the control group (HR 130 ± 16 bpm, p < 0.001). After rewarming it was seen increase of the left and right cardiac output (CO) compared to the hypothermia period (left CO 214 ± 39 ml/kg/min versus 155 ± 47 ml/kg/min, p < 0.001; right CO 369 ± 141 ml/kg/min versus 269 ± 113 ml/Kg/min, p = 0.005), remaining significantly higher than in the control group (left CO 174 ± 47 ml/kg/min, p = 0.004 and right CO 288 ± 74 ml/Kg/min, p = 0.02). CONCLUSIONS: The LV function remains stable in the two phases of TH, showing low left cardiac impairment of the induced cooling. The values of EF, shortening fraction and RV s´ wave were higher after rewarming, possibly due to a hyperdynamic heart state. A right ventricular dysfunction was observed when the pulmonary artery systolic pressure was high. The RV GLS was the only tool able to identify the RV systolic impairment during TH.

A clonagem animal por transferência nuclear de células somáticas (SCNT) é uma técnica de reprodução assistida que consiste em transferir o núcleo de uma célula de interesse a um oócito previamente enucleado. Sua utilização ainda apresenta eficiência baixa, com perdas embrionárias principalmente no início da gestação, ou em outras fases da gestação e no período perinatal devido à interação materno-fetal anormal com malformações diversas na placenta. Após o nascimento, a mortalidade está entre 12,5 e 42% devido às anormalidades neonatais já descritas como a síndrome do large offspring, com fetos exageradamente grandes, desenvolvimento anormal da placenta e crescimento não sincronizado de órgãos. Também são relatadas malformações musculoesqueléticas, aumento do diâmetro do cordão umbilical, dificuldades respiratórias e anormalidades metabólicas. Acredita-se que o mecanismo desta síndrome esteja relacionado com a reprogramação nuclear. Alinhando a gravidade das alterações e o custo elevado da técnica, torna-se necessário entender os mecanismos dessas alterações e desenvolver estratégias para prevenção e terapias para minimizar perdas. A avaliação dos parâmetros hematológicos e bioquímicos pode auxiliar no diagnóstico e acompanhamento terapêutico do neonato. O objetivo deste estudo foi avaliar os parâmetros clínicos, hematológicos, bioquímicos e de hemogasometria de bezerros clonados por SCNT, comparando os resultados com aqueles de bezerros gerados a partir de inseminação artificial. Dos bezerros clonados deste estudo, quatro vieram a óbito no período pós-natal. Alterações comuns nestes bezerros e que não ocorreram com os demais foram: pesos extremos ao nascimento, muito altos ou muito baixos; avaliação baixa no APGAR, principalmente após 5 minutos do nascimento; presença de líquido amniótico com viscosidade elevada; pH sanguíneo baixo imediatamente após o nascimento e elevação da creatinina sérica. As alterações nestes parâmetros em bezerros neonatos clonados podem indicar um risco de complicação no quadro geral dos clones, forçando medidas intensivas no tratamento para preservar a vida dos mesmos. Outras alterações frequentes nos clones, mas que não estavam necessariamente relacionadas a um quadro de risco foram: aumento do diâmetro dos vasos umbilicais; pH elevado ao nascimento e que evoluiu para acidose respiratória, acidose metabólica ou acidose mista respiratória e metabólica; elevação do volume celular médio; leucocitose por neutrofilia que foi observado em todos os clones devido à administração de corticoides ao nascimento; elevação gradual da contagem de plaquetas; diminuição da concentração de creatinina sérica e da atividade de AST. A gamaglutamiltransferase apresentou uma elevação mais discreta nos clones, podendo indicar uma falha na transferência de imunidade passiva. A concentração de lactado apresentou-se elevada em todos os clones em algum momento do período perinatal, indicando o quadro de acidose metabólica / Animal cloning by somatic cell nuclear transfer (SCNT) is an assisted reproductive technique in which the nucleus of a donor cell is transferred to a previously enucleated oocyte. Despite its potential benefits to research and agriculture, only 1% of the reconstructed oocytes develop into live healthy neonates. Embryo losses may occur early in pregnancy or in other stages of gestation, and during the perinatal period. These losses have been associated to abnormalities in maternal-fetal interaction, probably due to a deficient placental vascularization. Mortality rates after birth range between 12,5 to 42%, and the main abnormalities are related to the large offspring syndrome, with overly large cattle, abnormal placental development, and desynchronized organ development. Other problems reported include muscleskeletal disorders, enlarged umbilical cord, respiratory distress and metabolic disorders. The mechanism of this syndrome is probably related to nuclear reprogramming. Considering the severity of these abnormalities and the high costs of the technique, it is necessary to understand the mechanisms that lead to the pathology and develop strategies for preventing and treating the affected animals, minimizing financial losses. The evaluation of hematological and biochemical parameters is a very important tool for diagnosis and therapeutics. The aim of this study was to evaluate clinical, hematological and biochemical profiles, including blood gas analysis in calves originated by SCNT embryos, as well as comparing the same results from artificial insemination (AI) bred calves (control group). Amongst the cloned calves in this study, four died in the post-natal period. The most common abnormalities seen in these calves and that did not affect the others were: extreme birth weights (low or high), low APGAR score, especially when evaluated 5 minutes after birth, viscous amniotic fluid, low blood pH measured immediately after birth and high serum levels of creatinine. These abnormalities may present a risk of general health impairment in cloned calves, imposing better intensive care treatment in order to minimize death losses. Other frequent abnormalities in clones, but not necessarily related to risk of neonatal death immediately after birth are: enlarged umbilical vessels, high blood pH at birth that progresses to respiratory acidosis, metabolic acidosis or mixed respiratory metabolic acidosis, high mean cell volume, leukocytosis with neutrophilia due to glucocorticoids therapy after birth was observed in all of our clones, gradual increase in platelet count, low creatinine levels and low aspartate aminotransferase levels. There was a slight increase in gamma glutamyltransferase in clones compared to controls, which represent a poor passive immunity transfer. Lactate levels were high in all of the cloned animals at some point of the perinatal period, showing that they suffer from some degree of metabolic acidosis

Estima-se que a mortalidade neonatal canina nas primeiras semanas de vida seja de 30%, em razão de diversas causas, dentre elas falhas de assistência neonatal. Em Medicina Humana, protocolos de assistência cardio-respiratória ao recém-nascido estão bem estabelecidos e são utilizados de rotina. Porém, os cuidados direcionados aos neonatos debilitados em Medicina Veterinária são, em geral, empíricos e passíveis de causar traumas e contusões. Deste modo, objetivou-se comparar o padrão do aparelho respiratório ao nascimento e a evolução durante a primeira hora de vida em neonatos nascidos em eutocia via vaginal ou cesariana eletiva; propor um protocolo de conduta para a avaliação do aparelho respiratório de neonatos nascidos em eutocia ou cesariana, por meio da auscultação cardio-torácica, do escore Apgar, hemogasometria, avaliação radiográfica pulmonar e da determinação do surfactante no líquido amniótico; relacionar o exame clínico geral com a avaliação específica do aparelho respiratório; estabelecer a análise de maior sensibilidade e especificidade na identificação de distúrbios respiratórios neonatais; quantificar os fosfolipídeos lecitina (L) e esfingomielina (E) no líquido amniótico; estabelecer a relação L/E, como indício de maturidade pulmonar. Utilizou-se 41 neonatos divididos em 2 grupos conforme a condição obstétrica: eutocia (1) ou cesariana eletiva (2). Foram avaliados o escore Apgar, temperatura corpórea e exame físico completo aos 0, 5 e 60 minutos pós-natal; hemogasometria venosa aos 0 e 60 minutos do nascimento e padrão radiográfico pulmonar ao nascimento. Houve significativo aumento dos valores de Apgar no decorrer da primeira hora de vida. Entretanto, o grupo 2 apresentou escore inferior ao nascimento e após 5 minutos. A temperatura corpórea neonatal apresentou significativa queda ao longo da primeira hora de vida, para ambos os grupos, com hipotermia após 5 e 60 minutos do nascimento. A auscultação pulmonar indicou irregularidade do padrão respiratório, presença de ruído respiratório de moderado a intenso e episódios de agonia respiratória, com evolução satisfatória ao longo da primeira hora de vida para ambos os grupos. Filhotes nascidos de cesariana apresentaram maior percentual de alterações radiográficas, com moderada a intensa opacificação pulmonar difusa, com pouca ou nenhuma definição da silhueta cardíaca e luz dos brônquios principais. Ao nascimento e após 1 hora, todos os neonatos apresentaram acidemia, sendo esta do tipo mista para o grupo 1 e do tipo respiratória para o grupo 2. Após 60 minutos houve parcial evolução do desequilíbrio ácido-básico em ambos os grupos. Não houve diferença estatística entre a relação L/E dos grupos 1 e 2 com valores de 7,29 (±3,55) e 5,89 (±4,87), respectivamente. Conclui-se que o padrão de análise do aparelho respiratório neonatal variou conforme a condição obstétrica; as variáveis de maior sensibilidade e especificidade para identificação de neonatos com distúrbios respiratórios ao nascimento foram auscultação torácica associada à avaliação hemogasométrica das variáveis pH e pCO2; os fosfolipídeos lecitina e esfingomielina presentes no líquido amniótico foram quantificados e a relação L/E estabelecida e indicou maturidade pulmonar independente da condição obstétrica. / Technical and scientific deficit related to veterinary neonatology is conspicuous. It is known that the canine mortality rate is up to 30% in the first weeks of life. In Human Medicine, neonatal cardio-respiratory assistance is well established and widely used. Thus, the objectives of the present study were to compare the respiratory system pattern at birth and its evolution during the first hour of life in puppies born through eutocia or cesarian section; to standardize neonatal respiratory system assessment under distinct obstetrics conditions; to correlate clinical general variables to the specific respiratory ones; to identify the most sensible and specific variables in order to attain neonatal respiratory diagnosis; to quantify the phospholipids lecithin (L) and sphingomielin (S) in amniotic fluid; to establish the L/S ratio and its correlation with lung maturity. Forty-one canine neonates were allocated into 2 groups according to the whelping condition: group 1 - eutocia and group 2 - elective cesarean section. The following assessments were performed at 0, 5 and 60 minutes after birth: Apgar score and rectal temperature. Venous hemogasometric evaluation was attained after birth and 1 hour later. Lung x-ray was performed between 0 and 5 minutes of life. Group 2 neonates showed lower vitality, with Apgar score significantly inferior at birth and after 5 minutes. Nevertheless, there was full satisfactory recovery at 5 minutes in both groups, with the Apgar score superior to 7. There was a significant reduction in rectal temperature with hypothermia at 5 and 60 minutes of birth in both groups. Respiratory pattern was irregular at lung auscultation, with mild to moderate sounds, but all neonates evolved properly among the first hour of life. Lung x-rays indicated relevant alterations in 17% of the puppies of group 1 and 30% of group 2. Cardiac silhouette and the main caudal bronchi were clearly visualized and the image of the thymus appeared like an enlarged domed volume in cranial mediastin, adjacent to the heart. The radiographic findings ranged from mild to moderate diffuse or restricted opacification of pulmonary parenchyma. Little or no definition of the cardiac silhouette, the main bronchi and the vagueness of the thymus were all findings consistent with pulmonary edema. All puppies presented acidemia at 0 and 60 minutes after birth, with partial recovery of the acid-base disorder in both groups during the first hour of life. L/S ratio was 7,29 (±3,55) for group 1 and 5,89 (±4,87) for group 2, with no statistical difference between them. In conclusion, obstetric condition influences neonatal respiratory pattern evaluation; lung auscultation associated with pH and pCO2 hemogasometric values, which were more sensible and specific to identify respiratory disorders at birth; lecithin and sphingomielin were quantified in the amniotic fluid; L/S ratio was established and indicated lung maturity regardless of the whelping condition.

A presente pesquisa avaliou a determinação dos valores da pressão da artéria pulmonar, da oximetria, da hemogasometria e dos teores plasmáticos de lactato em bezerros neonatos, com a finalidade de contribuir nos estudos de clonagem e no desenvolvimento de neonatologia veterinária. A monitorização logo após o parto e o nascimento se tornou necessária para a manutenção da vida destes animais, aprimorando-se os protocolos e procedimento tomados, a avaliação clínica do sistema cardiovascular e respiratório neste momento de transição e a partir disto, o objetivo deste trabalho foi padronizar a metodologia utilizada para avaliações hemodinâmica da pressão da artéria pulmonar por meio da utilização do cateter de Swan-Ganz em bezerros, padronizar a técnica de oximetria e correlacionar os resultados obtidos para saturação de oxigênio com aqueles encontrados na hemogasometria de sangue arterial, e estabelecer valores de referência e avaliar a influência dos primeiros 30 dias de vida na mensuração da pressão da artéria pulmonar, da oximetria, da hemogasometria e dos teores plasmáticos de lactato obtidos em bezerros sadios. Foram utilizados 10 bezerros hígidos do estado de São Paulo, acompanhados do nascimento aos 30 dias de vida, onde pudemos observar o fechamento do forame ovale e ducto arterioso na 1º semana de vida, utilizando o sangue misto, o sangue venoso também foi um ótimo avaliador de distúrbios acidobásico, no entanto não avalia a função respiratória; para isso bastou utilizar a oximetria de pulso como um método não invasivo, que nos fornece dados que a gasometria arterial iria fornecer com a saturação de oxigênio. E a mensuração do lactato sérico serve como um marcador biológico para prognóstico de diversas enfermidades, onde seu aumento no sangue demonstra uma má perfusão tecidual (hipóxia) / This study investigated the measurement of the pulmonary artery pressure, pulse oximetry, the blood gas, plasma lactate and glucose levels in newborn calves, in order to contribute in cloning studies and the development of neonatal veterinary medicine. Monitoring soon after birth or help the calving became necessary for the maintenance of life of these animals, improving the protocols and procedures taken, the clinical assessment of cardiovascular and respiratory systems in this time of life transition, the objective of this study was to standardize the methodology used for hemodynamic assessment of pulmonary artery pressure using a Swan-Ganz catheter in calves, standardize the technique of pulse oximetry and correlate the results obtained for oxygen saturation found in blood gas analysis of arterial blood, and set reference values and to evaluate the influence of the first 30 days of life in the measurement of pulmonary artery pressure, pulse oximetry, blood gas and the plasma lactate levels obtained in healthy calves. We used 10 calves healthy from Sao Paulo state, followed from birth to 30 days of life, where we could see the closure of the foramen ovale and ductus arteriosus in the 1st week of life, using the mixed blood, venous blood was also a great evaluator acid-base disturbance, but does not assess respiratory function. The pulse oximetry was good enough to evaluate the oxygen saturation like a noninvasive method. And the measurement of serum lactate serves as a biomarker for prognosis of various diseases, when increase in blood shows poor tissue perfusion (hypoxia)

Introdução: O Doppler tecidual (DT) surgiu como uma técnica ecocardiográfica para registro das velocidades do miocárdio e evoluiu para a determinação da deformação miocárdica regional com medida do strain rate (SR) e strain longitudinal e radial unidimensionais. Nosso objetivo foi determinar padrões de normalidade em neonatos e analisar seqüencialmente esses índices em períodos de alta e baixa resistência vascular pulmonar. Casuística e Método: Selecionaram-se 55 crianças com idade média de 20,14 ± 14,0 horas, constituindo o Grupo I (G I). Um segundo exame foi realizado em 30 crianças que retornaram após 31,9 ± 2,9 dias de vida, constituindo o Grupo II (G II). As velocidades do DT pulsado foram obtidas em cortes transversais (R) e longitudinais (L) do ventrículo esquerdo (VE) em posições apical 4 e 2 câmaras e no VD (paredes livre e inferior). Foram medidas velocidades sistólicas (onda Sm), diastólica inicial (Em), diastólica final (Am) de pico e a relação Em/Am. Pelo menos três ciclos cardíacos consecutivos com taxa de quadros/s superior a 300 foram digitalmente obtidos nos cortes mencionados e analisados posteriormente utilizando programa específico para medida das curvas de SR/strain e seus componentes sistólico, diastólico inicial e final. Resultados: As velocidades demonstraram gradiente bem definido com redução progressiva na direção base-ápice do coração. As velocidades do VD foram superiores às do VE quando comparadas com as medidas nas paredes septal (S), anterior (A) e lateral (L). No GI verificamos diferença significativa entre as medidas do SR/strain sistólicos do segmento basal da parede S em relação à apical (-1,90 ± 0,61, - 25,90 ± 4,90 vs -1,66 ± 0,25, - 24,23 ± 3,08), p=0,04 e p=0,02 e do segmento médio em relação ao apical (p=0,01 e 0,02). A avaliação regional do VD demonstrou strain sistólico maior no segmento médio em relação ao basal (-33,20 ± 6,34 vs -28,38 ± 4,90, p=0,00) e em relação ao segmento apical (-33,20 ± 6,34 vs -31,95 ± 5,06, p=0,021). Os valores absolutos de SR/strain e todos os seus componentes foram maiores na direção R quando comparados com a L (SR sistólico 2,99 ± 0,78 s-1 vs (-)1,90 ± 0,60 s-1 strain sistólico 49,72% ± 12,86% vs (-) 25,86% ± 4,83 p=0,00). Quando comparamos os GI e GII verificamos redução do strain sistólico do VE na direção R e L nas paredes S, L e A em todos os segmentos. O SR sistólico reduziu apenas na porção basal da parede L (-1,91 ± 0,46 s-1 vs - 1,71 ± 0,33 s-1, p=0,02). O VD apresentou no GII aumento significativo do strain sistólico e diastólico inicial em todos os segmentos e paredes. O SR sistólico também apresentou aumento dos valores nos segmentos basal e médio de sua parede livre e na parede inferior. A correlação entre a onda Sm e SR/strain sistólicos não foi significativa. Conclusão: Os índices regionais de deformação miocárdica constituem técnica clínica reproduzível em neonatos e podem monitorar alterações seqüenciais fisiológicas da circulação neonatal precoce e tardia. São mais robustos que as velocidades na quantificação da função regional. / Background: Color Doppler myocardial imaging (CDMI) has emerged as an echocardiographic technique for determining myocardial velocities and has been further developed to allow the determination of one-dimension regional longitudinal and radial strain rate (SR)and strain. Our goal was to determine normal values in neonates and sequentially analyse these indices in periods of high and low pulmonary vascular resistance. Study population and methods: Fifty-five term newborns with mean age of 20.14 ± 14.0 hours were selected to be part of Group I (GI). A second echo study was performed on 30 children that had returned with 31.9 ± 2.9 days after birth, being Group II (GII). Pulsed wave Doppler tissue velocities (PWDTV) were obtained in short axis (R) and longitudinal (L) axis of the left ventricle (LV) in apical 4 and 2 chamber view and in 4 and 2 chamber of the right ventricle (RV), including RV free lateral and inferior walls. Peak systolic (Sm), peak early diastolic (Em) and peak late diastolic (Am) motion velocities and Em/Am ratio were measured. At least three consecutive cardiac cycles with frame rate more than 300 fps were stored in digital format from the mentioned views for offline analysis by using dedicated software for measuring peak systolic and peak early and late diastolic SR/strain. Results: PWTDV have shown a well-defined gradient with progressive peak reduction from base to apex. RV velocities were higher than those of the LV whem compared to septal (S), anterior (A) and lateral (L) walls. In GI there was a significant difference between systolic SR/strain measurement of basal S segment in relation to apical (-1.90 ± 0.61, -25.90 ± 4.90 vs -1.66 ± 0.25, - 24.23 ± 3.08), p=0.04 e p=0.02 and from the mid in relation to the apical segment (p=0.01 e 0.02). Regional RV longitudinal function showed that systolic strain recorded from the mid segment was significantly higher than that recorded from the basal segment (-33.20 ± 6.34 vs -28.38 ± 4.90, p=0.00) and that from the apical segment (-33.20 ± 6.34 vs ?31.95 ± 5.06, p=0.021). The absolute and all components of SR/strain were significantly higher in R direction when compared to the L ones (systolic SR 2.99 ± 0.78 s-1 vs (-)1.90 ± 0.60 s-1 systolic strain 49.72% ± 12.86% vs (-)25.86% ± 4.83 p=0.00). When comparing data from GI and GII, we noticed reduction of LV systolic strain in the second group for both R and L, in all segments of S, L and A walls. Systolic SR showed reduction of the values in GII only in the basal segment of the L wall (-1.91 ± 0.46 s-1 vs ?1.71 ± 0.33s-1, p=0.02). Regional RV function showed systolic and early diastolic strain significantly higher in all segments of wall in GII. Systolic SR also showed higher values in the basal and mid segments of RV free lateral and inferior wall in GII when comparing to GI. The correlation between peak systolic velocity Sm and peak systolic SR/strain was not significant. Conclusion: Regional myocardial deformation indices are reproducible clinical techniques in neonates and can monitor physiological sequential circulatory changes of the early and late neonatal period. They are more robust than velocities in the quantification of the regional myocardial function.