Central chemical regulation of breathing movements in fetal lambs

Physiological control of fetal heart rate variability during labour: Implications and controversies

The interpretation of fetal heart rate (FHR) patterns is the only available method to continuously monitor fetal wellbeing during labour. One of the most important yet contentious aspects of the FHR pattern is changes in FHR variability (FHRV). Some clinical studies suggest that loss of FHRV during labour is a sign of fetal compromise so this is reflected in practice guidelines. Surprisingly, there is little systematic evidence to support this observation. In this review we methodically dissect the potential pathways controlling FHRV during labour-like hypoxaemia. Before labour, FHRV is controlled by the combined activity of the parasympathetic and sympathetic nervous systems, in part regulated by a complex interplay between fetal sleep state and behaviour. By contrast, preclinical studies using multiple autonomic blockades have now shown that sympathetic neural control of FHRV was potently suppressed between periods of labour-like hypoxaemia, and thus, that the parasympathetic system is the sole neural regulator of FHRV once FHR decelerations are present during labour. We further discuss the pattern of changes in FHRV during progressive fetal compromise and highlight potential biochemical, behavioural and clinical factors that may regulate parasympathetic-mediated FHRV during labour. Further studies are needed to investigate the regulators of parasympathetic activity to better understand the dynamic changes in FHRV and their true utility during labour. This article is protected by copyright. All rights reserved.

Animal welfare aspects in respect of the slaughter or killing of pregnant livestock animals (cattle, pigs, sheep, goats, horses)

This scientific opinion addresses animal welfare aspects of slaughtering of livestock pregnant animals. Term of Reference (ToR) 1 requested assessment of the prevalence of animals slaughtered in a critical developmental stage of gestation when the livestock fetuses might experience negative affect. Limited data on European prevalence and related uncertainties necessitated a structured expert knowledge elicitation (EKE) exercise. Estimated median percentages of animals slaughtered in the last third of gestation are 3%, 1.5%, 0.5%, 0.8% and 0.2% (dairy cows, beef cattle, pigs, sheep and goats, respectively). Pregnant animals may be sent for slaughter for health, welfare, management and economic reasons (ToR2); there are also reasons for farmers not knowing that animals sent for slaughter are pregnant. Measures to reduce the incidence are listed. ToR3 asked whether livestock fetuses can experience pain and other negative affect. The available literature was reviewed and, at a second multidisciplinary EKE meeting, judgements and uncertainty were elicited. It is concluded that livestock fetuses in the last third of gestation have the anatomical and neurophysiological structures required to experience negative affect (with 90-100% likelihood). However, there are two different possibilities whether they perceive negative affect. It is more probable that the neurophysiological situation does not allow for conscious perception (with 66-99% likelihood) because of brain inhibitory mechanisms. There is also a less probable situation that livestock fetuses can experience negative affect (with 1-33% likelihood) arising from differences in the interpretation of the fetal electroencephalogram, observed responses to external stimuli and the possibility of fetal learning. Regarding methods to stun and kill livestock fetuses at slaughter (ToR4), sets of scenarios and respective actions take account of both the probable and less probable situation regarding fetal ability for conscious perception. Finally, information was collated on methods to establish the dam's gestational stage based on physical features of livestock fetuses (ToR5).

Fetal breathing movements and changes at birth

The fetus, which develops within a fluid-filled amniotic sac, relies on the placenta for respiratory gas exchange rather than the lungs. While not involved in fetal oxygenation, fetal breathing movements (FBM) nevertheless have an important role in lung growth and in development of respiratory muscles and neural regulation. FBM are regulated differently in many respects than postnatal respiration, which results from the unique intrauterine environment. Prominent distinctions of FBM include its episodic nature and apnea-sensitivity to hypoxia. The latter characteristic is the basis for using FBM in the assessment of fetuses at risk for hypoxic injury. At birth, the transition to continuous postnatal respiration involves a fall in temperature, gaseous distention of the lungs, activation of the Hering-Breuer reflexes, and functional connectivity of afferent O2 chemoreceptor activity with respiratory motoneurons and arousal centers. Importantly, exposure to drugs or adverse conditions in utero not only can change patterns of FBM but also can lead to epigenetic dysregulation in postnatal respiration. Such changes, can blunt respiratory and arousal defenses against hypoxic challenges in sleep. Thus, fetal hypoxia and/or drug exposure may in later life dispose sleeping infants, children, and adults to hypertension, diabetes mellitus, brain injury, and sudden death.

The role of CO(2) and central chemoreception in the control of breathing in the fetus and the neonate

Central chemoreception is active early in development and likely drives fetal breathing movements, which are influenced by a combination of behavioral state and powerful inhibition. In the premature human infant and newborn rat ventilation increases in response to CO(2); in the rat the sensitivity of the response increases steadily after ∼P12. The premature human infant is more vulnerable to instability than the newborn rat and exhibits periodic breathing that is augmented by hypoxia and eliminated by breathing oxygen or CO(2) or the administration of respiratory stimulants. The sites of central chemoreception active in the fetus are not known, but may involve the parafacial respiratory group which may be a precursor to the adult RTN. The fetal and neonatal rat brainstem-spinal-cord preparations promise to provide important information about central chemoreception in the developing rodent and will increase our understanding of important clinical problems, including The Sudden Infant Death Syndrome, Congenital Central Hypoventilation Syndrome, and periodic breathing and apnea of prematurity.

Fetal cardiovascular reflex responses to hypoxaemia

The fetus mounts a coordinated cardiovascular response to an insult of acute hypoxaemia which involves neural and endocrine components. During acute hypoxaemia in late pregnancy there is a transient bradycardia, a gradual increase in arterial blood pressure and an increase in heart rate variability. In addition, there is a redistribution of the combined ventricular output favouring the cerebral, myocardial and adrenal circulations by shunting blood away from the peripheral circulations. A component of the increase in peripheral vascular resistance and the increase in arterial blood pressure during acute hypoxaemia is mediated via increases in plasma concentrations of vasoconstrictor hormones such as vasopressin, angiotensin II and neuropeptide Y. Whilst an increase in plasma ACTH and cortisol is also seen during acute hypoxaemia, their contribution to cardiovascular control in fetal sheep is less clear.

Evidence has been presented to suggest that a number of these cardiovascular and endocrine responses to acute hypoxaemia are chemorefiex in nature, mediated principally by carotid chemoreceptor afferents. In addition, this reflex may be modifiable in terms of changes in magnitude and gain: first, by an influence of the intrauterine environment during chronic hypoxaemia and second, through genetic influences, in animals adapted to life at high altitude.

Intiation of lung ventilation at birth

The newborn baby draws its first postnatal breath either during or within seconds of delivery. Within minutes, a regular breathing rhythm is established and this remains virtually continuous for the remainder of postnatal life. The mechanisms responsible for these sudden, dramatic and vital changes in the respiratory system at birth are only partially understood. Since fetuses make intermittent breathing movements long before birth, understanding the control of the fetal respiratory system may be essential to understanding the rapid onset of respiratory efforts at delivery. In this review the stimuli present at birth will be considered and, based on our current understanding of the fetal and neonatal respiratory control systems, those factors which are likely to play an important role in the initiation of lung ventilation at this time will be examined. Normal respiratory events in the early postnatal period will be concentrated on, but it is important to recognize that in some cases problems occur: a neonate may fail to initiate breathing efforts rapidly, or an apparently healthy premature neonate may suddenly stop breathing a few days after birth. In both cases, clinical intervention may be required to maintain adequate gas exchange and to prevent brain damage or death. Clearly, greater knowledge of respiratory control during this critical time of life would assist in the development of more appropriate and successful treatments for these life-threatening disorders.

Factors influencing adenovirus-mediated airway transduction in fetal mice

Intra-amniotic injection of adenovirus allows transduction of the fetal airways following natural fetal breathing movements. This administration method is promising for use in gene therapy for cystic fibrosis and other diseases for which the main target for exogenous gene expression is the lung. Here we have investigated factors that may affect the efficacy of gene transfer to the murine fetal lung. We examined marker compound distribution and transgene expression (from a first-generation adenoviral vector) at different stages of development. This demonstrated that fetal breathing movements at 15-16 days of gestation are of sufficient intensity to carry marker/vector into the fetal lungs. These movements can be significantly stimulated by the combination of intra-amniotic theophylline administration and postoperative exposure of the dam to elevated CO(2) levels. However, the most important factor for efficient and consistent pulmonary transgene delivery is the dose of adenoviral vector used, as both the degree of transduction and the percentage of lungs transduced increases with escalating viral dose.

Assessment of fetal heart rate and fetal movements in detecting oxygen deprivation in-utero

This article reviews the physiological principles underlying the application of assessment of fetal movements and fetal heart rate (FHR) in detecting fetal hypoxia. Studies in both fetal sheep and healthy human fetuses are discussed including those which have demonstrated the importance of appreciating the existence of rest-activity cycles under normal physiological conditions. The role of adenosine in mediating the hypoxic inhibition of fetal breathing movements (FBMs) is reviewed as is the previously unrecognized importance of fetal gasping as a possible new measure of fetal hypoxia.

Maturation of the mammalian respiratory system

In this review, the maturational changes occurring in the mammalian respiratory network from fetal to adult ages are analyzed. Most of the data presented were obtained on rodents using in vitro approaches. In gestational day 18 (E18) fetuses, this network functions but is not yet able to sustain a stable respiratory activity, and most of the neonatal modulatory processes are not yet efficient. Respiratory motoneurons undergo relatively little cell death, and even if not yet fully mature at E18, they are capable of firing sustained bursts of potentials. Endogenous serotonin exerts a potent facilitation on the network and appears to be necessary for the respiratory rhythm to be expressed. In E20 fetuses and neonates, the respiratory activity has become quite stable. Inhibitory processes are not yet necessary for respiratory rhythmogenesis, and the rostral ventrolateral medulla (RVLM) contains inspiratory bursting pacemaker neurons that seem to constitute the kernel of the network. The activity of the network depends on CO2 and pH levels, via cholinergic relays, as well as being modulated at both the RVLM and motoneuronal levels by endogenous serotonin, substance P, and catecholamine mechanisms. In adults, the inhibitory processes become more important, but the RVLM is still a crucial area. The neonatal modulatory processes are likely to continue during adulthood, but they are difficult to investigate in vivo. In conclusion, 1) serotonin, which greatly facilitates the activity of the respiratory network at all developmental ages, may at least partly define its maturation; 2) the RVLM bursting pacemaker neurons may be the kernel of the network from E20 to adulthood, but their existence and their role in vivo need to be further confirmed in both neonatal and adult mammals.

Development of chemosensitivity of rat medullary raphe neurons

In many neonatal mammals, including humans and rats, there is a developmental increase in the ventilatory response to elevated pCO2. This maturation of central respiratory chemoreception may result from maturation of intrinsic chemosensitivity of brainstem neurons. We have examined age-related changes in chemosensitivity of neurons from the rat medullary raphe, a putative site for central chemoreception, using perforated patch-clamp recordings in vitro. In brain slices from rats younger than 12 days old, firing rate increased in 3% of neurons and decreased in 17% of neurons in response to respiratory acidosis (n = 36). In contrast, in slices from rats 12 days and older, firing rate increased in 18% of neurons and decreased in 15% of neurons in response to the same stimulus (n = 40). A tissue culture preparation of medullary raphe neurons was used to examine changes in chemosensitivity with age from three to 74 days in vitro. In cultured neurons younger than 12 days in vitro, firing rate increased in 4% of neurons and decreased in 44% of neurons in response to respiratory acidosis (n = 54). In contrast, in neurons 12 days in vitro and older, firing rate increased in 30% of neurons and decreased in 24% of neurons in response to respiratory acidosis (n = 105). In both types of chemosensitive neuron ("stimulated" and "inhibited"), the magnitudes of the changes in firing rate were greater in older neurons than in young neurons. These results indicate that the incidence and the degree of chemosensitivity of medullary raphe neurons increase with age in brain slices and in culture. This age-related increase in cellular chemosensitivity may underlie the development of respiratory chemoreception in vivo. Delays in this maturation process may contribute to developmental abnormalities of breathing, such as sudden infant death syndrome.

Identification of brainstem neurons responding to hypoxia in fetal and newborn sheep

Hypoxia causes a reversible decrease in the level of respiratory, oculomotor and postural muscle activity in fetal sheep, an effect not seen in newborn lambs. We have used Fos immunohistochemistry to identify neurons which are activated by hypoxia and which may mediate this motor inhibition in the fetus. Pregnant sheep of either 117 or 138 days gestation were made hypoxic by allowing them to breathe 8-9% O2 for 2 h. Compared to age-matched control fetuses, hypoxia caused a significant increase in Fos-immunoreactivity in several medullary nuclei including the nucleus tractus solitarius, lateral reticular nucleus and the rostral ventrolateral medulla and also in the lateral parabrachial nucleus, locus coeruleus and subcoeruleus region in the pons. Hypoxia in newborn lambs, 7-18 days old, resulted in Fos staining in the same medullary and pontine nuclei with the exception of the subcoeruleus region which was devoid of Fos-immunoreactivity. In newborn lambs in which the carotid sinus nerves had been sectioned bilaterally, Fos-immunoreactivity was increased in the nucleus tractus solitarius in the medulla and in the locus coeruleus, lateral parabrachial and Kölliker-Fuse nuclei in the pons when compared to intact control newborn lambs. When carotid sinus nerve denervated-lambs were subjected to hypoxia the pattern of Fos-ir was similar to the pattern seen in the denervated control lambs but in addition staining was present in the subcoeruleus. These results suggest that a specific set of pontine neurons are activated by low oxygen levels in the fetus but not in the newborn lamb in the presence of an intact innervation from the carotid sinus. We hypothesise that: (a) in the fetus hypoxia activates neurons in the region of the subcoeruleus and this causes cessation of breathing movements and muscle atonia; and (b) that after birth stimulation of the carotid chemoreceptors by hypoxia normally inhibits activation of these subcoeruleus neurons.

Effect of medullary lesions, vagotomy and carotid sinus denervation on fetal breathing

Chronically prepared fetal sheep were subjected to bilateral surface lesions of the Area "S" on the ventrolateral medulla and/or to peripheral chemoreceptor denervation by section of the vagus, sinus or both nerves. Sino-aortic denervation or Area "S" lesions reduced the incidence of fetal breathing (FB) for several days. Area "S" lesions also disrupted the pattern of FB; diaphragmatic EMG activity initially was mostly tonic and then of very high frequency, up to 7 Hz. Incidence and pattern of FB generally recovered by 7 days, but mean Ti was reduced in Area "S" lesioned fetuses (0.14 +/- 0.01 sec) compared to nonlesioned fetuses (0.19 +/- 0.01 sec) (P < 0.0001). Respiratory sensitivity to CO2 was variable but not different between control, denervated, and Area "S" lesioned groups. Eight of eight fetuses with Area "S" lesions were unable to initiate breathing at birth, but three sham operated fetuses were born normally. These data suggest that the classical peripheral and central chemoreceptors have a negligible influence on the control of FB, and that breathing activity in the fetus is mediated by a different mechanism than during postnatal life.

Electrocortical activity, electroocular activity, and breathing movements in fetal sheep with prolonged and graded hypoxemia

OBJECTIVE

Our objective was to determine the effect of a prolonged and graded reduction in fetal arterial oxygen saturation on electrocortical activity and associated biophysical variables.

STUDY DESIGN

Fourteen unanesthetized fetal sheep were studied between 126 and 135 days' gestation with continuous monitoring of electrocortical and electroocular activity and breathing movements, during a 24-hour control period, and subsequently during 4 days of prolonged and graded hypoxemia induced by progressively lowering the maternal inspired oxygen concentration.

RESULTS

Graded reduction in fetal arterial oxygen saturation resulted in little change in arterial pH until close to 30% when metabolic acidemia was apparent. The incidence of low-voltage electrocortical activity, electroocular activity, and breathing movements were marginally decreased with hypoxemia alone; however, a significant decrease was not apparent until associated with the onset of fetal acidemia.

CONCLUSION

Hypoxemia of a chronic nature must approach the level at which acidemia becomes apparent before a marked change in fetal behavioral activity is noted.

Autoradiographic localization of adenosine A1 receptors in brainstem of fetal sheep

Quantitative autoradiographic techniques were used to localize adenosine A1 receptors at the light microscopic level with the antagonist [3H]8-cyclopentyl-1,3-dipropylxanthine [( 3H]DPCPX) in the brainstem of fetal sheep. Since adenosine has been proposed as a neuromodulator, which effects the depression of fetal breathing movements during hypoxia, attention was directed to respiratory neuronal areas. The highest density of A1 receptors in respiratory related groups was found in an area of the rostral ventrolateral medulla, which is ventral to the facial nucleus, caudal to the superior olive and lateral to the rostral inferior olive. Intermediate densities were seen in the medial and lateral parabrachial nuclei. Adenosine A1 receptor density was low in the areas of the nucleus of the solitary tract and the nucleus ambiguous. These data suggest that moderate hypoxia in the fetus may depress respiration by withdrawing a tonic stimulus at the level of the ventral lateral medullary chemoreceptors.

The effect of centrally administered adenosine on fetal breathing movements

The central effects of the adenosine analogue L-2-N6-(phenylisopropyl) adenosine (L-PIA) on breathing movements was determined by making injections into the fourth ventricle in unanesthetized fetal sheep. Administration of 0.5 micrograms L-PIA reduced the percent time during which fetal breathing occurred from 48.0 +/- 5.2 (SEM) to 19.5 +/- 6.1. Inspiratory slope was reduced to 62 +/- 5.5 and to 43 +/- 5.7 percent of the control values when 0.2 and 0.5 micrograms L-PIA were given respectively. The effects of L-PIA on the percent time fetal breathing movements occurred and on inspiratory slope were prevented by the prior systemic administration of theophylline (plasma concentrations approximately 15 micrograms/ml). When the vehicle for L-PIA, dimethyl sulfoxide in Ringer solution was given into the fourth ventricle or when 0.5 micrograms L-PIA was given systemically, there was no effect on fetal breathing. None of these protocols resulted in a change in sagittal sinus blood pH, PO2 or, PCO2. These data indicate adenosine acts at the brain stem to depress fetal respiratory drive.

Ductus arteriosus flow velocity modulation by fetal breathing movements as a measure of fetal lung development

A test is needed that would accurately predict favorable neonatal lung performance in the presence of prolonged severe oligohydramnios caused by ruptured membranes so that optimal obstetric care can be provided. We propose such a test that is based on the degree of modulation of fetal ductal blood flow velocity by fetal breathing movements after maternal glucose loading. In a prospective cross-sectional study of 49 normal pregnancies (50 fetuses) between 25 and 38 weeks an exponential increase in breathing-related ductal blood flow velocity modulation was observed with advancing gestational age, reflecting the developing pulmonary vascular bed. Fetal ductal flow velocity waveforms were also recorded in 13 cases of prolonged severe oligohydramnios after ruptured membranes before 28 weeks' gestation. Normal ductal blood flow velocity modulation values were associated with normal neonatal lung performance, whereas reduced ductal blood flow velocity modulation values were associated with pulmonary hypoplasia. Fetal breathing-related ductal flow velocity modulation appears to be a promising predictor of neonatal lung performance.

Control of fetal breathing in the human fetus between 24 and 34 weeks' gestation

The effect of induced maternal hypocapnia and hypercapnia on fetal breathing movements was studied in 30 healthy pregnant women between 24 and 34 weeks' gestation to determine whether gestational age influences the fetal respiratory response to alterations in carbon dioxide levels. The percent time of fetal breathing movements correlated significantly with maternal end-tidal PCO2, increasing with maternal breathing of 2% and 4% carbon dioxide and decreasing with maternal hyperventilation for each of the three gestational age groups studied. However, the slope of this response for the 28- to 30-week group (3.29) and for the 32- to 34-week group (3.66), although similar to that of the term fetus, was significantly greater than that for the 24- to 26-week group (1.18, p less than 0.001). We conclude that the carbon dioxide level in the preterm fetus (as in the term fetus) is an important stimulus for the generation of respiratory movements. However, a developmental change is evident; the 24- to 26-week fetus demonstrates a decreased respiratory response to tonic carbon dioxide input. This may account for the decreased incidence of fetal breathing movements in the fetus of younger gestational age.

The role of carbon dioxide in the generation of human fetal breathing movements

To determine the role of carbon dioxide in the generation of fetal respiratory movements, the effect of induced maternal hypocapnia and hypercapnia on fetal breathing movements, gross body movements, and fetal heart rate was studied in 12 healthy pregnant women near term. Patients were studied for a 1-hour control period breathing room air followed by four randomized 15-minute study periods with patients breathing either room air, a prepared gas mixture with 2% or 4% carbon dioxide, or undergoing controlled hyperventilation as determined by monitoring end-tidal PCO2. The percentage of time fetal breathing movements correlated significantly with maternal end-tidal PCO2 (r = 0.62, p less than 0.01), increasing with maternal breathing of 2% and 4% carbon dioxide and decreasing with maternal hyperventilation. Fetal gross body movements, fetal heart rate, and fetal heart rate variability showed no significant changes. It is concluded that as in adults, the carbon dioxide level in fetuses is an important stimulus for the generation of respiratory movements, acting independent of a change in behavioral state. It is hypothesized that tonic carbon dioxide level input is an important determinant of fetal respiratory center drive, but little or no phasic carbon dioxide input exists because of continuous placental excretion, thus resulting in the episodic occurrence of breathing movements with changes in the fetal behavioral state.

The effect of carbonic anhydrase inhibition on breathing movements and electrocortical activity in fetal sheep

Fetal breathing movements (FBM) indicated by repetitive negative intrathoracic pressures and biparietal electrocorticograms (ECoG) were recorded from 8 fetal sheep for 3 h before (control) and 3 h after the administration of a carbonic anhydrase inhibitor, acetazolamide. FBM and the low voltage (LV) ECoG state occurred 36 +/- 5% (SEM) and 60 +/- 3% of the control period, respectively. Virtually no FBM occurred during high voltage (HV) ECoG while in 57 +/- 6% of the LV state the fetuses were making FBM. The peak magnitude of the negative intrathoracic (tracheal) pressure deflections was 4 +/- 1 Torr. Following acetazolamide the incidence of FBM rose to 53 +/- 4% (P less than 0.01) but there was no significant change in the incidence of the LV state (58 +/- 3%). Most of the increase in the incidence of FBM remained confined to periods of LV ECoG activity so that an increased proportion of this state (88 +/- 2%, P less than 0.001) was occupied with respiratory efforts. The amplitude of the FBM also increased to 8 +/- 1 Torr (P less than 0.05). The increased incidence and depth of FBM is most likely due to an elevated hydrogen ion concentration and differs from a fetal respiratory acidosis induced by increasing the inspired CO2 fraction to the ewe in that the respiratory stimulation induced by acetazolamide is not associated with an increased incidence of the permissive LV ECoG state.

Central stimulation of breathing movements in fetal lambs by prostaglandin synthetase inhibitors

In unanaesthetized fetal lambs at 125-135 days gestation in utero central acidosis caused by perfusion of the cerebral ventricular system with a solution containing less than 1 mM-HCO3- (cerebrospinal fluid (c.s.f.) pH 6.98) or intravenous infusion of ammonium chloride (c.s.f. pH 7.1) produced an increase in the depth and frequency of episodic breathing but no change in electrocortical activity, heart rate or arterial pressure. Administration of prostaglandin synthetase inhibitors, sodium meclofenamate (0.8-10 mg/kg I.V. or 0.6-2.6 mg/kg intracerebrally) or acetylsalicylic acid (6.7 mg/kg I.V.) caused prolonged episodes of fetal breathing during low and high voltage electrocortical activity, with a large increase in breath amplitude. Blood gas values, heart rate, blood pressure, electrocortical activity and eye movements were not altered. In fetuses whose brain stems had been sectioned in the upper pons or the inferior colliculus, sodium meclofenamate induced prolonged deep breathing. Intravenous prostaglandin E2 abolished the continuous breathing induced by meclofenamate, but not breathing movements enhanced by hypercapnia or hypoxia. It is concluded that the central chemoreceptors respond to acidosis in near-term lamb fetuses qualitatively as in adult animals. Secondly, the results suggest that prostaglandin E2 and the inhibitors of prostaglandin synthesis also act centrally in the lower pons or medulla to modulate fetal breathing.

Fetal breathing movements and the response to carbon dioxide in patients on methadone maintenance

Fetal breathing movements were monitored on six methadone maintenance patients and ten healthy control patients, studied while breathing room air and while breathing a prepared gas mixture with 5% carbon dioxide, both before and 2 hours after either the usual daily dose of methadone or a diet drink. There was no difference before and after the diet drink in control patients, who showed a significant increase in the incidence of fetal breathing movements from 37.1% +/- 5.9% (SEM) on room air to 69.4% +/- 2.8% while breathing 5% carbon dioxide (p less than 0.01). In the patients studied on room air before receiving methadone, fetal breathing movements were significantly decreased from those of the control group, 4.7% +/- 1.2% (p less than 0.01), with a further decrease when studied after receiving methadone, 1.3% +/- 0.7%. Fetal breathing movements did increase significantly in response to 5% carbon dioxide both before and after receiving methadone; however, in both instances the incidence was significantly less that that of the control group. The findings of the present study on methadone subjects demonstrate that abnormal function of the respiratory control network is evident in utero, which may be predictive of subsequent neonatal respiratory development.

The effect of relative hypoxemia on the pattern of breathing movements in fetal lambs

To determine whether there is a causal relationship between transient, modest hypoxemia and fetal breathing movements (FBM), we first raised fetal descending aortic PO2 (PaO2) from 17.3 +/- 0.8 (SE) to 24.9 +/- 1.8 mm Hg by administering 50% O2 in N2 to a plastic bag over the ewe's head for 26.5 +/- 3.8 min, then changed to 21% O2 in N2. Fetal PaO2 returned to control levels over the next 5 min. In 4 of 20 experiments on 11 fetal lambs (121-142 days gestation), FBM were absent when the change in maternal inspired O2 concentration was made, and did not occur in the following 5 min. In 16 trials, FBM were present for 2.0-24.1 min prior to the change to 21% O2. In 4 of these, FBM ceased within 2.1 +/- 0.7 min of the change, i.e., before PaO2 had fallen to control levels. In the remaining 12, FBM continued for 4.7-15.9 (mean = 8.6 +/- 1.0) min after the change to 21% O2, and the amplitude of FBM increased significantly (P less than 0.01) from 5.4 +/- 0.7 to 9.5 +/- 1.4 mm Hg over the first 4 min. Thereafter amplitude declined to the end of the breathing episodes. It is concluded that transient, modest reductions in vascular PO2 during episodes of FBM are a stimulus for FBM. However, it appears that transient hypoxemia cannot stimulate FBM from apnea.

Cerebral blood flow and metabolism during morphine-induced stimulation of breathing movements in fetal lambs

Brain blood flow increased in the fetal lamb during morphine-induced stimulation of breathing. The increase in flow was 60% in the cerebral hemispheres and the cerebellum, and 100% in the midbrain plus rhinencephalon, pons, medulla and cervical spinal cord. Oxygen content of arterial blood decreased in all experiments and the arterial carbon dioxide tension increased in all but one of the experiments. The increase in cerebral blood flow observed is predicted by the changes in arterial oxygen content and carbon dioxide tension. Cerebral oxygen consumption and glucose utilization were not changed by morphine treatment. These results suggest that there is no direct effect of morphine upon cerebral blood flow and metabolism in the fetal lamb during morphine-stimulated breathing.