Plasma catecholamine concentrations in infants at birth and during the first 48 hours of life

Sympatho-adrenal response to hypoglycaemia in infants

The response of the sympathoadrenal system to hypoglycaemia of different etiology was studied in seven infants, aged 10-189 days. Five infants had hyperinsulinism secondary to nesidioblastosis or to a beta-cell adenoma of the pancreas, one infant had neonatal sepsis due to staphylococcal infection and one infant congenital growth hormone (HGH) and adrenocorticotropic hormone (ACTH) deficiency. In babies with hyperinsulinism, plasma noradrenaline increased from 0.29 +/- 0.03 to 0.61 +/- 0.09 ng/ml (P less than 0.01), whereas adrenaline increased only in three, but did not change in two babies. Increases in heart rate and blood pressure paralleled these changes. In hypoglycaemia due to congenital sepsis, noradrenaline increased from 0.39 to 1.64 ng/ml and adrenaline from 0.05 to 0.86 ng/ml. This was associated with marked haemodynamic changes. In congenital HGH and ACTH deficiency, the low basal plasma levels of noradrenaline (0.12 ng/ml) and adrenaline (0.01 ng/ml) remained unchanged in response to hypoglycaemia. Heart rate and blood pressure were unaffected. The sympathoadrenal system was activated by hypoglycaemia in all infants except in congenital HGH and ACTH deficiency. In contrast to adults, noradrenaline was the preferentially released catecholamine, suggesting an involvement of noradrenaline in glucose counter regulation in infancy.

Adrenocorticotropic hormone and catecholamines in maternal, umbilical and neonatal plasma in relation to vaginal delivery

The aim of this study was to evaluate the effect of vaginal delivery on both ACTH and catecholamines (DA, NE, E) secretion in the mother, the fetus (umbilical artery) and the newborn. Blood samples were obtained from 19 normal pregnant women and the corresponding umbilical cords, and from the newborns. Seventeen normal nonpregnant women, matched for age and parity, were also included in the study as "nonpregnant controls". The results demonstrate that in the mother, plasma catecholamines (CA) concentrations during labor and delivery are elevated above the values reported for normal nonpregnant women and there is a predominant E response. The concentrations of CA in umbilical arteries are very high compared to those in the corresponding mother and they fall rapidly after birth. Unlike that in the mother, the predominant CA response to parturition in the fetus and newborn infant is NE. The extraction rate of DA, NE and E from placenta is approximately 60%. The peripheral plasma levels of ACTH in pregnant women during labor are twice and 10 times as high as those observed in the corresponding umbilical arteries and in nonpregnant women respectively. At delivery they increase further. No significant differences are found between the values measured in the arterial cord blood and those in the venous cord blood and in the newborns. A way of explaining the prevalence of E and the higher ACTH/E ratio found in the mother in comparison with the fetus could be that in the mother the stress response to parturition is regulated mainly by the pituitary-adrenal axis, whereas in the fetus there is a prevalent stimulation of the sympathetic nervous system.

Cardiac function and sympathoadrenal activity in the newborn after cesarean section under spinal and epidural anesthesia

Left ventricular systolic time intervals, bupivacaine concentrations, adrenaline and noradrenaline levels were determined in 19 neonates delivered by elective cesarean section. Ten of the cesarean sections were performed under spinal and nine under epidural anesthesia. Plain bupivacaine 0.5% was used for the epidural anesthesia and bupivacaine 0.5% in glucose 8% for the spinals. The noradrenaline and adrenaline levels were higher in the neonates whose mothers received epidural anesthesia. The differences in catecholamine and bupivacaine concentrations were not associated with differences in left ventricular dynamics, or the timing of postnatal circulatory changes. The significant exposure of the neonate to bupivacaine, at maternal epidural anesthesia, seems to have no negative effect on early neonatal circulation in the healthy term infant.

Changes of the cardiovascular system during the perinatal period

After describing the particular features of the fetal circulation, changes in the pattern of blood flow at the time of birth and during early neonatal life are explained. From animal studies it is wellknown that during the first hours and weeks after birth newborns are characterized by an extremely high cardiac output due to high metabolic demands. In order to meet this marked volume loading, already under resting conditions the neonatal heart appears to be operating nearly at its full capacity without reserves in contractility, preload and afterload. Consequently the newborn heart has less ability to cope with additional acute afterload and/or preload stress. Few investigations on cardiac output and myocardial performance in healthy human newborns provide presumptive evidence that the postnatal human heart performs probably as well as the heart of other species. These observations may influence the therapeutic approach in clinical situations with additional alterations in loading conditions.

In utero right ventricular output in the fetal lamb: the effect of heart rate

1. The effect of heart rate on right ventricular output was examined in six lambs during a period extending from 126 to 139 days of gestation. The fetuses had been surgically instrumented at least four days previously with a main pulmonary artery flow probe, right ventricular dimension transducers and left and right atrial pacing electrodes. 2. During spontaneous variations in heart rate, rate was correlated positively with right ventricular output (P less than 0.0001) and end-diastolic dimension (P less than 0.0001) among the lambs considered as a group, but no significant effect of rate on stroke volume was found. When individual responses were examined, output increased significantly with rate in sixteen out of seventeen observations. 3. With left atrial pacing, heart rate did not affect output. With right atrial pacing, rate correlated negatively with output (P less than 0.0001). With pacing from either site, rate correlated negatively with end-diastolic dimension (P less than 0.0001) and stroke volume (P less than 0.0001). 4. The introduction of a longer period interval during each pacing rate inhibited the rate-related decrease in dimension and allowed the ventricle to fill to the same end-diastolic dimension. The systole following these longer intervals had a greater stroke volume than did the preceding systoles with smaller end-diastolic dimension. The faster the preceding paced rate, the greater was the increase in stroke volume (P less than 0.001). 5. Right ventricular dimensions and volumes were measured in vitro, and the relationship was found to be linear using regression analysis. 6. This study demonstrates that experimentally induced variations in heart rate produce changes in end-diastolic volume and contractility which prominently affect right ventricular stroke volume. As a consequence, rate has, over a broad range, either no significant effect on output or a negative one. With spontaneous variations in rate, additional changes in contractility and venous return occur which affect stroke volume and end-diastolic volume and enhance right ventricular output. These relationships are similar to those in the adult heart, and demonstrate the absence of a maturational change in the effects of rate on ventricular function from the fetus to the adult.

Dopamine pharmacokinetics in critically ill newborn infants

To compare clinical responses with plasma concentrations of dopamine and to compare dopamine pharmacokinetics in infants of different gestational age or clinical condition, dopamine was administered under carefully controlled conditions of dose and rate of infusion. The dose was increased stepwise from 1 to 2, to 2 to 4, and 4 to 8 micrograms/kg/min. Plasma concentrations of catecholamines, including dopamine, were compared with blood pressure, heart rate, and Doppler cardiac output. The data were analyzed to determine the threshold or minimal plasma concentration of dopamine necessary to produce discernible effects. Plasma clearance rate was calculated from steady-state plasma concentrations. The average threshold for increases in mean arterial pressure was 50% below that for increases in heart rate. Improvements in arterial pressure were noted before and at lower thresholds than for increases in heart rate. Serial echocardiographic data showed dose-dependent increases in cardiac output and stroke volume without significant change in heart rate or systemic vascular resistance. Thresholds and plasma clearance values were similar in infants of gestational age 27 to 42 weeks and birth weights 900 to 4300 g. Administration of dopamine at initial dosages lower than commonly recommended, followed by incremental increase in dose, may be associated with improved left ventricular performance with avoidance of undesirable tachycardia and arrhythmias.

Plasma catecholamines following nursing procedures in a neonatal ward

Plasma catecholamines (CA) were determined in arterial blood from infants in a neonatal ward before and after various management procedures. Special care led to a 60% increase in plasma noradrenaline levels (P less than 0.02) whereas the adrenaline concentrations were not significantly affected. CA levels tended to be slightly higher after heel prick and gavage feeding than before, but the differences were not significant.

Blunted response of maternal ovine placental lactogen levels to arginine stimulation after single umbilical artery ligation in pregnant sheep

Ovine placental lactogen levels in the maternal circulation are significantly reduced after single umbilical artery ligation in pregnant sheep. We report the ovine placental lactogen response to high-dose amino acid stimulation in four ewes with fetuses that underwent single umbilical artery ligation and six control ewes with fetuses that underwent sham operation. After maternal infusion with 50 gm of arginine in 350 ml of distilled water, mean ovine placental lactogen levels in ewes with fetuses that underwent single umbilical artery ligation increased by 170%, while mean levels in control ewes increased by 294%. Maternal infusions with hypertonic saline solution of osmolality and volume equal to those of the arginine solutions failed to increase maternal ovine placental lactogen levels. Fetal well-being, both during and after the maternal arginine infusions, was confirmed by unchanged fetal arterial blood gases and catecholamines. The ovine placental lactogen levels in the fetal circulation were not altered by maternal arginine infusion. These data suggest that the correlation between maternal ovine placental lactogen levels and functioning placental mass may be enhanced by arginine stimulation. The possible use of this provocation of placental lactogen levels as a test of placental function in clinical practice is discussed.

The effect of heart rate on in utero left ventricular output in the fetal sheep

The effect of heart rate on left ventricular output was examined in seven fetal lambs at ages of 128 to 140 gestational days. The fetuses had been surgically instrumented at least 4 days previously with an ascending aortic flow probe, left ventricular dimension transducers, and left and right atrial pacing electrodes. Natural variations in heart rate of the lambs taken as a group correlated positively with left ventricular output, and negatively with ventricular end-diastolic dimension and stroke volume (P less than 0.0001). Rate did not affect output with right atrial pacing. With left atrial pacing, it correlated negatively with output (P less than 0.0001). At both pacing sites, rate correlated negatively with end-diastolic dimension and stroke volume (P less than 0.0001). The introduction of a longer interval during each pacing rate circumvented the rate-related changes in dimension and allowed the ventricle to fill to the same end-diastolic dimension. The systole at the end of the longer interval had a greater stroke volume than the preceding systoles. The faster the preceding paced rate, the greater was the stroke volume (P less than 0.0001). This study demonstrates that experimentally induced variations in heart rate produce changes in end-diastolic volume and contractility which prominently affect stroke volume. Over a broad range of rates, however, the effect of rate on left ventricular output is either negative or absent. With naturally occurring rate changes, there are additional changes in contractility and venous return which affect stroke volume. These combine to produce a positive relation between heart rate and left ventricular output. These effects of heart rate on output are qualitatively similar to those described for the adult animal.

Different mechanisms underlying reduced beta 2-adrenoceptor responsiveness in lymphocytes from neonates and old subjects

To investigate the mechanism underlying age-dependent changes in beta-adrenoceptor function we have determined beta 2-adrenoceptor density (by (+/-)-125iodocyanopindolol (ICYP) binding) and beta 2-responsiveness (cyclic AMP responses to isoprenaline stimulation) in lymphocytes derived from 20 neonates, 54 young adults (19-30 years) and 15 old subjects (60-86 years). In young adults the mean number of lymphocyte beta 2-adrenoceptors amounted to 862 +/- 36 (range 500-1560) ICYP binding sites/cell (N = 54); it was slightly higher in old subjects with 1230 +/- 94 (698-1980) ICYP binding sites/cell (N = 15). In contrast, lymphocytes derived from neonatal blood had a significantly lower mean beta 2-adrenoceptor number (385 +/- 35 (130-608) ICYP binding sites/cell, N = 20, P less than 0.01). (-)-Isoprenaline (0.01-100 microM)-induced increases in lymphocyte cyclic AMP content were significantly lower in neonates and old subjects than in young adults. While for neonates and young adults significant positive correlations between beta 2-adrenoceptor density and 10 microM (-)-isoprenaline-induced cyclic AMP increases exist, in old subjects cyclic AMP increases were much lower than could be expected from the beta 2-adrenoceptor number. It is concluded that the mechanism underlying reduced beta 2-adrenoceptor responsiveness in neonates and old subjects is different: while in neonates it seems to be due to the reduced beta-adrenoceptor number, in old subjects it is caused by a post-receptor defect--presumably by a decreased activity of the adenylate cyclase.

Catecholamines in arterial and venous umbilical blood: placental extraction, correlation with fetal hypoxia, and transcutaneous partial oxygen tension

In 34 parturient women the levels of free epinephrine (E), norepinephrine (NE), and dopamine (D) were determined by a radioenzymatic method using maternal venous and umbilical arterial and venous blood. The study was conducted to investigate the relationship between fetal catecholamines and hypoxia, fetal heart rate (FHR), and transcutaneous pO2 (tcpO2). The placental catecholamine extraction rates were also calculated. Results The NE concentrations (10,200 pg/ml) and the E concentrations (1,120 pg/ml) in the fetal arterial blood were highly elevated with mean values increased 4-fold over umbilical vein values. Compared with the maternal venous blood, NE values were increased 20-fold, and E values 10-fold. Free D concentrations in fetal arterial blood (130 pg/ml) had risen 2.5-fold over maternal levels. These results suggest that the catecholamines measured in cord blood are of fetal origin and that the placenta has a high capacity for inactivation of free catecholamines. The placental extraction rate is 77 +/- 14% for NE, 76 +/- 16% for E, and 33 +/- 25% for D. The placental extraction rates for E and NE were virtually identical; in agreement with morphological studies they demonstrated absence of sympathetic innervation on the fetal side of the placenta. Highly significant correlations were found between fetal arterial NE concentrations and the 1-minute APGAR score, pH and base deficit in the umbilical artery and alterations of the FHR (deceleration area, baseline FHR). Further analysis of FHR alterations reveals that an increase in deceleration area without tachycardia is not correlated with an increase of fetal arterial NE concentration. A significant rise in NE was only found with additional tachycardia which is often associated with a loss of oscillation amplitude. Fetal arterial E concentrations were found to correlate with the fetal parameters indicating increased adrenal secretion of the hormone during fetal stress. However, correlation coefficients were lower than those obtained for NE. A significant effect of fetal hypoxia on arterial and venous D levels could not be demonstrated. Fetal tcpO2 varies between 0-25 mm Hg during the last two hours before delivery. In most cases tcpO2 was lower than the arterial pO2. Besides epidermal thickness and artifacts, skin perfusion is a major factor influencing the tcpO2 (transcutaneous arterial pO2 difference). Vasoconstriction of the cutaneous vessels induced by increased NE secretion during hypoxia may obviously produce a fall in tcpO2.(ABSTRACT TRUNCATED AT 400 WORDS)

Endocrinology of human parturition: a review

The existing data on the hormonal factors involved in human parturition indicate that the steroid hormones, progesterone and the oestrogens, play only a facilitatory role in the initiation of labour. A definite role for fetal adrenal steroids in this process has yet to be established, and they too may serve only a facilitating function. The stimulation of the uterine muscle during labour results from an interaction of oxytocin and prostaglandin (PG) F2 alpha. Recent evidence suggests that oxytocin is most important for the initial phase of labour, whereas increased synthesis of PGF2 alpha is essential for the progression of labour. The role of PGE2 remains unclear, but this PG may play an important role in the ripening of the cervix which in turn is essential for successful parturition. The finding of maximal oxytocin receptor concentrations in the myometrium in labour adds strong support to the notion that oxytocin is the trigger for uterine contractions. The factors which control oxytocin receptor formation are therefore important; this may be one of the processes where the steroids play a crucial role. Oxytocin is also one of the stimuli that increase uterine PG synthesis; the coupling of oxytocin receptor occupancy and PG synthetase activity in uterine tissues may be another crucial factor in the mechanism of labour. The formation of gap junctions between the myometrial cells also seems essential for the synchronization and progression of myometrial activity. We propose, therefore, that the co-ordinating of oxytocin receptor formation, PG synthesis and gap junction formation is a key to the initiation and maintenance of human labour. The fetus may fulfil such a co-ordinating role through its influence on placental oestrogen production, through mechanical distention of the uterus, and through its secretion of neuro-hypophysial hormones and other stimulators of PG synthesis.

Catecholamine surge and metabolic adaptation in the newborn after vaginal delivery and caesarean section

The immediate postnatal metabolic adaptation and sympatho-adrenal activation were studied in infants delivered vaginally or by elective caesarean section. Vaginally delivered infants showed high catecholamine levels at birth compared to infants born by caesarean section under epidural or general anaesthesia. Umbilical arterial glucose levels were significantly higher in the vaginal group than in both caesarean section groups. At 30 min, all groups showed a marked decrease with several infants showing asymptomatic hypoglycaemia in the caesarean section group. C-peptide levels showed no difference at birth but later became significantly higher in the vaginal group. Although the levels of free fatty acids and glycerol were low at birth, they were significantly higher in the vaginal group. In all groups they increased substantially with time. Considering the marked differences in catecholamine levels, the differences in metabolic adaptation were unexpectedly small. This implies an attenuated metabolic response to sympatho-adrenal stimulation in the newborn.

Fetal catecholamine release with preterm delivery

Neurosympathetic system activity at birth was studied by measuring umbilical arterial plasma catecholamine concentrations in 36 preterm fetuses. Umbilical arterial catecholamine concentrations were correlated with blood gas status, mode of delivery, fetal sex, and fetal heart rate patterns. Significant correlations were observed for plasma norepinephrine and epinephrine versus fetal pH and PO2 and for plasma dopamine versus pH but not PO2. These catecholamine relationships to acidosis and hypoxia were similar to those of our previously published data for term fetuses. Norepinephrine and dopamine concentrations were similar in both preterm and term fetuses; however, epinephrine levels were significantly greater in preterm fetuses than in term fetuses. Increased concentrations of norepinephrine, epinephrine, and dopamine were observed in association with abnormal fetal heart rate patterns. There was no significant effect of fetal sex on the catecholamine secretory response. Similar cord catecholamine concentrations were observed following vaginal and cesarean section delivery, the latter with and without labor. These results indicate that the preterm fetus, like the term fetus, responds to stress at delivery with a graded catecholamine release. The observation of greater epinephrine concentrations in preterm fetuses than in term fetuses may reflect increased secretion or decreased clearance of epinephrine.

Studies on equine prematurity 2: Post natal adrenocortical activity in relation to plasma adrenocorticotrophic hormone and catecholamine levels in term and premature foals

Adrenocortical and medullary function was investigated during the immediate post natal period in premature and full term foals. High plasma cortisol concentrations were characteristic of the term foals in the first 2 h after birth and these were accompanied by significant arteriovenous differences in plasma cortisol across the umbilical circulation at birth, indicating enhanced adrenal activity before delivery. No such arteriovenous differences were detected in the premature group and post natal changes in plasma cortisol were minimal. The apparent inability of the premature foal adrenal to secrete cortisol was not due to the lack of endogenous adrenocorticotrophic hormone (ACTH) because high levels of this hormone were found immediately after birth in both groups of foals. Tests on the sensitivity of the foal adrenal to exogenous ACTH1-24 (0.125 mg intramuscularly [im]) showed that a maximum response to this hormone could be elicited in term foals on the day of birth. Subsequently basal cortisol levels and the response of the adrenal to ACTH1-24 declined. By contrast, only a slight response was observed following the same dose of ACTH1-24 in the premature group. Exposure to Depot ACTH1-24 over 24 h enhanced the basal secretion of cortisol in both premature and term foals but no consistent response to the same ACTH test dose could be elicited in the former. A wide range of total plasma catecholamine concentrations was observed in both groups of newborn foals. The highest values were seen in acidotic animals and there was a significant inverse relationship between blood pH and total plasma catecholamine level at delivery.(ABSTRACT TRUNCATED AT 250 WORDS)

Fetal-perinatal catecholamine secretion: role in perinatal glucose homeostasis

Secretion of catecholamines may play an important role in several of the adaptations that characterize the transition from intra- to extrauterine life including cardiovascular, respiratory, and metabolic events, specifically the initiation of endogenous glucose production following curtailment of the transplancental maternal supply of glucose. Maturation of neural and enzymatic pathways involved in catecholamine secretion occurs late in gestation; fetal hypoxia can produce a 20- and 125-fold increase in plasma epinephrine (E) and norepinephrine (NE), respectively. Estimates of turnover (approximately 2,000 pg X kg-1 X min-1) and metabolic clearance rates (20-40 ml X kg-1 X min-1) indicate active secretion and metabolism of E from fetal sources with negligible transfer from the mother. Simultaneously, there is maturation of functional alpha- and beta-adrenergic receptors. At birth, plasma E and NE rise three- to tenfold; plasma levels are higher in hypoxic infants and lower in prematures. Concurrently, glucagon increases three- to fivefold; cortisol and growth hormone also are high, whereas insulin remains low and poorly responsive to stimuli; the number of glucagon receptors increases, whereas that of insulin decreases. Acting in concert these hormonal changes activate glycogenolysis, gluconeogenesis, lypolysis, and ketogenesis. Glucose production and gluconeogenesis, absent in utero, become evident within hours of birth in both humans and sheep. The spontaneous surge in catecholamine secretion at birth may be the key event because infusion of E or NE to fetal sheep in late gestation simulates the metabolic and hormonal profile of glucagon and insulin as well as glucose production that normally only occur with separation of the placenta.

Sympathoadrenal activity and peripheral blood flow after birth: comparison in infants delivered vaginally and by cesarean section

The possible influence of sympathoadrenal activity on peripheral blood flow was studied. Limb blood flow was measured with venous occlusion plethysmography at 30 minutes, 2 hours, and 24 hours after birth in 24 healthy, full-term infants, of whom 14 were delivered by elective cesarean section. Mean arterial pressure was simultaneously measured noninvasively, and peripheral vascular resistance calculated. Umbilical artery blood at birth and peripheral venous blood at 2 and 24 hours were analyzed for concentrations of catecholamines and hematocrit. The limb blood flow was significantly lower at 30 minutes in the vaginally delivered infants compared with those delivered by cesarean section. There was a gradual increase in limb blood flow over the 24 hours in those delivered vaginally, whereas in the section group only small changes were observed. The peripheral vascular resistance was higher both at 30 minutes and at 2 hours in those delivered vaginally, which corresponded to the higher catecholamine concentrations at birth and at 2 hours in this group. Two hours after birth there was a significant correlation between noradrenaline levels and peripheral vascular resistance. The results indicate that the sympathoadrenal system influences peripheral circulation at birth and is important in the circulatory adaptation of the newborn infant.

Fetal catecholamines

Experimental data from fetal human and animal research suggest that the fetal sympathoadrenal system, composed of the adrenal medulla, sympathetic neurons, and extra-adrenal chromaffin tissue functions from early fetal life to maintain fetal homeostasis. The extra-adrenal chromaffin tissue undergoes maturation at 9 to 11 weeks of gestation, whereas the adrenal medulla and sympathetic nervous system mature later in fetal life. The fetal catecholamine response to hypoxia, mediated predominantly by norepinephrine, is an important component of the fetal cardiovascular response to hypoxia, i.e., through alpha-receptor stimulation, fetal cardiac output redistribution occurs. Fetal catecholamine secretion in response to substrate availability, through alpha- and beta-receptor stimulation, provide a mechanism by which the fetus can utilize its own substrate stores. Pulmonary beta-receptor stimulation by catecholamines has been demonstrated to increase lecithin synthesis, increase surfactant secretion, and decrease lung fluid production near term. beta-Receptor stimulation has also been demonstrated to have trophic effects on the development of thermogenic brown adipose tissue. Although the exact stimulus for the initiation of parturition in the primate is unknown, fetal catecholamines, through direct myometrial alpha-adrenergic or dopaminergic receptor stimulation and/or through the stimulation of prostaglandin production, have the potential of facilitating the onset of parturition.

Evaluation of sympathetic nervous system and adrenomedullary activity in normal children

In 22 healthy children heart rate, blood pressure and plasma levels of epinephrine (E) and norepinephrine (NE) were evaluated under basal conditions and in response to standing (5 min). Basal plasma E and NE levels found in these children were (means +/- S.E.M.) 139 +/- 17.9 pg/ml and 236 +/- 31.0 pg/ml respectively. Ten out of the 22 children reported dizziness and discomfort by the end of the 5 min standing period. These children showed not only a greater decrease in both systolic and diastolic blood pressure but also a lower basal heart rate, a tendency to higher basal NE levels and a blunted plasma NE response (23 +/- 7%) when compared with children not reporting symptoms (60 +/- 9%, P less than 0.01). Plasma E levels also showed an increment although a wide range of individual responses was observed in both groups.

Plasma noradrenaline and adrenaline in infants of diabetic mothers at birth and at two hours of age

Plasma noradrenaline and adrenaline in the umbilical artery were very high in many infants of both diabetic mothers (IDM) and non-diabetic mothers (controls) compared to values obtained in adults. Blood pH was slightly but significantly lower in IDM than in controls at delivery. There was a significant negative correlation between plasma noradrenaline and blood pH in IDM at birth, but no correlation between plasma noradrenaline and blood glucose, birth weight and Apgar scores. Plasma noradrenaline decreased significantly from birth to two hours of age both in IDM and controls. At two hours of age plasma noradrenaline and adrenaline were significantly greater in IDM compared to controls whereas blood glucose concentration was lower in the former group. There was a close inverse correlation between plasma noradrenaline and adrenaline, respectively, and blood glucose in IDM at two hours of age but not in controls. The elevated plasma noradrenaline at delivery in IDM may be explained by clinically undetectable acidosis whereas elevated plasma catecholamines at two hours are probably due to hypoglycaemia.

The effect of labor on maternal and fetal circulating catecholamines

Maternal circulating catecholamines were determined in nonpregnant (n = 15) and antepartum (n = 15) subjects and at spontaneous vaginal (n = 20) and repeat cesarean section (n = 20) deliveries. Newborn levels of catecholamines were determined prior to the onset of respiration in the vaginal delivery (n = 20) and cesarean section (n = 20) groups. Maternal levels of norepinephrine at 36 to 38 weeks' gestation were lower than values in nonpregnant individuals, and did not increase at cesarean section but rose to nonpregnant levels at vaginal delivery. Antepartum levels of epinephrine were lower than levels in nonpregnant subjects and rose above nonpregnant levels in both delivery groups (P less than 0.02). Maternal levels of dopamine followed a similar pregnancy decline and rose above nonpregnant levels at delivery in both groups (P less than 0.02). Maternal levels of dopamine in the cesarean section group were significantly higher than those in vaginal delivery (P less than 0.05). Newborn levels of catecholamines demonstrated significant newborn secretion of norepinephrine, epinephrine, and dopamine at delivery in both groups. Umbilical arterial levels of norepinephrine and epinephrine were significantly greater after vaginal delivery than those after abdominal delivery (P less than 0.01). The significance of circulating catecholamines to, and their possible roles in, the parturient women and fetus are discussed.

Fetal and maternal plasma catecholamine levels at elective cesarean section under general or epidural anesthesia versus vaginal delivery

Fetal and maternal plasma levels of catecholamines were measured at birth in 40 women with normal term pregnancies who underwent elective cesarean section. Twenty women were operated on under general anesthesia, and 20 under epidural anesthesia. For comparison, the same measurements were also made in 10 women who underwent vaginal delivery without signs of intrapartum fetal distress. Maternal venous levels of catecholamines were elevated in all three groups as compared to values in the resting adult. The highest levels were found in the vaginal delivery group (norepinephrine and epinephrine, 3.9 +/- 2.1 and 1.1 +/- 1.0 nmoles/L, respectively), and the lowest in the epidural cesarean section group. Fetal outcomes were similar in all three groups, as judged by Apgar scores and by measurements of umbilical arterial blood gases. In spite of that, neonates delivered vaginally showed a markedly higher sympathoadrenal activation (norepinephrine and epinephrine, 31.8 +/- 24.1 and 5.1 +/- 7.6 nmoles/L, respectively) than those born by elective cesarean section. In the latter group, however, it was found that the type of maternal anesthesia influenced fetal sympathoadrenal activation, since neonatal levels of catecholamines were higher in the epidural section group (norepinephrine and epinephrine, 9.5 +/- 6.4 and 4.0 +/- 4.5 nmoles/L, respectively) than in the general anesthesia group (norepinephrine and epinephrine, 3.2 +/- 2.7 and 1.0 +/- 1.4 nmoles/L, respectively). These results may have a certain clinical relevance since fetal sympathoadrenal activation is thought to promote extrauterine adaptation.

Circumstances influencing umbilical-cord plasma catecholamines at delivery

Blood gases and plasma catecholamines were measured in umbilical arterial and venous blood samples after delivery. In all cases umbilical arterial noradrenaline concentrations were higher than venous levels. The lowest concentrations of noradrenaline were found after elective caesarean section. Vaginal delivery, particularly when accompanied by instrumental manipulation, was associated with significantly higher concentrations of arterial noradrenaline. High concentrations of catecholamines were commonly recorded in those deliveries showing evidence of acid-base disturbance. Noradrenaline was the predominant catecholamine in all cases. A linear relation was demonstrated between arterial noradrenaline and arteriovenous noradrenaline difference.