# Optimizing Transition with Delayed Umbilical Cord Clamping and Supplemental Oxygen during Preterm Resuscitation with Perinatal Asphyxia

> **NIH NIH R03** · STATE UNIVERSITY OF NEW YORK AT BUFFALO · 2020 · $79,750

## Abstract

ABSTRACT
Premature babies account for 10% of births in the United States; these newborn have immature
lungs and often need help breathing at birth. Surfactant deficiency, immature antioxidant system
and the need for extended mechanical ventilation support can cause damage to the lungs and
other organs resulting in increased morbidity and mortality. Recent studies have shown that
infants born <28 weeks’ gestation had a higher risk of mortality when initially ventilated with 21%
oxygen. The higher mortality was due to respiratory failure, which could be due to underdeveloped
lungs, impaired oxygenation and impaired blood flow to the lungs. The Neonatal Resuscitation
Program (NRP) developed by the American Academy of Pediatrics (AAP) provides guidelines for
clinical treatment that sets target oxygen saturation goals. A recent study emphasized the
importance of these target goals and failure to reach these targets by 5 min lead to higher
mortality. The ancient practice of keeping the umbilical cord intact (attached to placenta) when a
premature baby needs resuscitation could potentially help transition.
In this proposal, we plan to study initiation of ventilation following preterm delivery in a fetal lamb
model with low heart rate (<90/min), with 30% or 60% initial oxygen and titrate based on target
oxygenation while the umbilical cord is still intact. We will compare this to resuscitation without an
intact cord using similar initial oxygen concentration (30% or 60%). We will study the changes at
transition by measuring oxygenation, pulmonary and cerebral blood flow and oxidative injury in
these 4 groups. In this way, we can compare physiologic changes and the resultant oxidative
stress markers to better understand what may be happening during the human preterm transition.
Optimizing the initial oxygen exposure with an intact cord in a depressed preterm animal model
examines this problem in a controlled way. Real-time continuous measurements of cerebral
oximetry, systemic and pulmonary flow and pressure variations during the preterm transition will
contribute to reducing morbidity and mortality in these babies.
Relevance to current practice in neonatal resuscitation:
Establishing good oxygen supply following birth is critical and it is more difficult to achieve with
premature lung disease. Current AAP-NRP guidelines are vigilant to protect newborns from
oxidative stress injury by targeting oxygen saturation ranges and limiting exposure to high oxygen
concentrations. This newer approach examines physiology at birth in preterm lambs to establish
optimal oxygen requirements with an intact umbilical cord to achieve the transition to air breathing
with minimal oxidative damage.

## Key facts

- **NIH application ID:** 9975860
- **Project number:** 5R03HD096510-02
- **Recipient organization:** STATE UNIVERSITY OF NEW YORK AT BUFFALO
- **Principal Investigator:** Praveen Chandrasekharan
- **Activity code:** R03 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $79,750
- **Award type:** 5
- **Project period:** 2019-07-10 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9975860

## Citation

> US National Institutes of Health, RePORTER application 9975860, Optimizing Transition with Delayed Umbilical Cord Clamping and Supplemental Oxygen during Preterm Resuscitation with Perinatal Asphyxia (5R03HD096510-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9975860. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*