Effects of nociceptive stimuli on the pulmonary circulation in the ovine fetus

Pregnancy in Slaughtered Lambs and Sheep—A Cross-Sectional Study in Three Abattoirs in Switzerland

Simple Summary

The slaughtering of pregnant livestock and its relevance to animal welfare has become an ethically controversial topic. In this study, the prevalence of sheep and lambs being slaughtered while pregnant in Switzerland was assessed as well as the stage of pregnancy and the life signs of the fetuses. Data collection was carried out over one year in three Swiss abattoirs. Overall, 7.6% of the female animals were pregnant at slaughter, and 25.5% of them were in the third trimester of pregnancy, where 81.1% of the fetuses showed signs of life, such as a heartbeat or umbilical artery pulsation. To assess the relevance of animal welfare, it is discussed whether fetuses feel pain and stress. Even though science disagrees as to whether fetuses are capable of feeling conscious pain, it cannot certainly be ruled out, which is why the slaughter of pregnant sheep and lambs should be minimized as much as possible.

Abstract

The slaughter of pregnant sheep and goats is not restricted in Switzerland. The aim of this study was to assess the prevalence of pregnant sheep and lambs being slaughtered in Switzerland and to determine the state of gestation and vital signs of the fetuses in order to assess the need to take measures and raise awareness of this issue. The data collection was carried out from March 2021 to February 2022, comprising 115 days in three abattoirs. A total of 18,702 sheep and lambs were included in this cross-sectional study, and 8770 were female (46.9%), 663 of which were pregnant at slaughter (7.6%). The pregnancy rate varied by age category: 404 lambs (6.1%) and 259 sheep (11.9%) were pregnant. The highest pregnancy rate was found in winter (25.7%). Among the 663 pregnancies, more than a quarter were multiple pregnancies (28.2%). A total of 169 animals were in the third trimester of pregnancy (25.5%), where living fetuses were mainly found (81.1%). As it cannot be definitively ruled out that fetuses feel conscious pain, the data from this study underline that, from an ethical point of view, there is a need for action and that measures must be taken to reduce the number of pregnant slaughtered animals.

Prostaglandin E1 in infants with congenital diaphragmatic hernia (CDH) and life-threatening pulmonary hypertension

BACKGROUND

Suprasystemic pulmonary hypertension (PH) is highly predictive of pulmonary morbidity and death in infants with congenital diaphragmatic hernia (CDH).

OBJECTIVES

To report the effects and tolerability of Prostaglandin E₁ (PGE₁) in newborns with severe CDH and life-threatening PH.

METHODS

Newborn infants with isolated CDH and life-threatening PH defined by an acute worsening of the cardiorespiratory function, and bidirectional or exclusive right-to-left shunting across the ductus arteriosus (DA) with an acceleration of the blood flow >1.5 m.s^-1 assessed by Doppler echocardiography. Serial measurements of cardiorespiratory variables have been recorded before and after PGE₁.

RESULTS

18 infants (out of 102 in the cohort) were included in the study (gestational age: 39 ± 2 weeks). The median FiO₂, and preductal and postductal SpO₂ were 80% [50; 100], 91% [88; 95] and 86% [82; 91], respectively, before treatment. FiO₂ decreased to 35% [30-40] (p = 0.001) at H6. Maximal blood flow velocities in the DA decreased after starting PGE₁ from 2.2 m.s^-1 [1.5-2.5] to 1 m.s^-1 [0.55-1.2] (p < 0.001).

CONCLUSIONS

PGE₁ treatment improved oxygenation and circulatory function in newborn infants with severe CDH and life-threatening PH. Our data provide evidence that restrictive DA may result in suprasystemic pulmonary hypertension in CDH infants, and that PGE₁ may improve cardiorespiratory failure through reopening of the DA.

TYPE OF STUDY

Treatment study.

LEVEL OF EVIDENCE

Level III.

Review shows that implementing a nationwide protocol for congenital diaphragmatic hernia was a key factor in reducing mortality and morbidity

The French Rare Disease Reference Center for congenital diaphragmatic hernia (CDH) was created in 2008, to implement a national protocol for foetuses and children with this serious condition. Neonatal mortality from CDH is 30-40%, mainly due to pulmonary hypoplasia and persistent pulmonary hypertension, and half of those who live have high respiratory, nutritional and digestive morbidity. CDH management requires long-term and specialised multidisciplinary care. It has been well established that a standardised management protocol improves the prognosis of children with CDH.

CONCLUSION

Organising health care and implementing a nationwide French protocol were key factors for reducing mortality and morbidity from CDH.

Pathophysiology of persistent pulmonary hypertension of the newborn: impact of the perinatal environment

The main cause of pulmonary hypertension in newborn babies results from the failure of the pulmonary circulation to dilate at birth, termed 'persistent pulmonary hypertension of the newborn' (PPHN). This syndrome is characterized by sustained elevation of pulmonary vascular resistance, causing extrapulmonary right-to-left shunting of blood across the ductus arteriosus and foramen ovale and severe hypoxaemia. It can also lead to life-threatening circulatory failure. There are many controversial and unresolved issues regarding the pathophysiology of PPHN, and these are discussed. PPHN is generally associated with factors such as congenital diaphragmatic hernia, birth asphyxia, sepsis, meconium aspiration and respiratory distress syndrome. However, the perinatal environment-exposure to nicotine and certain medications, maternal obesity and diabetes, epigenetics, painful stimuli and birth by Caesarean section-may also affect the maladaptation of the lung circulation at birth. In infants with PPHN, it is important to optimize circulatory function. Suggested management strategies for PPHN include: avoidance of environmental factors that worsen PPHN (e.g. noxious stimuli, lung overdistension); adequate lung recruitment and alveolar ventilation; inhaled nitric oxide (or sildenafil, if inhaled nitric oxide is not available); haemodynamic assessment; appropriate fluid and cardiovascular resuscitation and inotropic and vasoactive agents.

[Bronchopulmonary dysplasia-associated pulmonary arterial hypertension of very preterm infants]

Bronchopulmonary dysplasia (BPD) of very preterm infants is a multifactorial chronic lung disease and its incidence has not decreased despite improvements in neonatal intensive care, including lung protective strategies. Pulmonary hypertension (PH) can complicate the course of BPD. Mortality in infants with BPD-associated PH is thought to be very high, but its incidence is unknown and a standard diagnostic and therapeutic strategy has not been well defined. In this article, we will first describe the current knowledge on the BPD-associated PH and the current treatments available for this pathology. We will then present the HTP-DBP Study, carried out in Paris (France) starting in 2012. The diagnosis of PH is suspected on echocardiographic criteria, but cardiac catheterization is considered the gold standard for diagnosis and evaluation of the severity of PH. Moreover, pulmonary vasoreactivity testing is used to guide the management of patients with PH. The pathogenesis of BPD-associated PH is poorly understood and even less is known about appropriate therapy. Today, optimizing ventilation and reducing the pulmonary vascular tone with specific pulmonary vasodilatator drugs are the main goals in treating HTP-associated DBP. Animal studies and a few clinical studies suggest that medications targeting the nitric oxide (NO) signaling pathway (NO inhalation, oral sildenafil citrate) could be effective treatments for BPD-associated PH, but they have not been approved for this indication. The HTP-DBP study is a French multicenter prospective observational study. The objective is to evaluate the frequency of BPD-associated PH, to describe its physiopathology, its severity (morbidity and mortality), and the effectiveness of current treatments.

Effects of environmental tobacco smoke on the pulmonary circulation in the ovine fetus

OBJECTIVE

Epidemiologic studies have highlighted an association between maternal smoking and persistent pulmonary hypertension of the newborn infant. However, the impact of exposure to tobacco smoke on the perinatal pulmonary circulation is currently unknown. The purpose of this study was to assess the pulmonary vascular effects of environmental tobacco smoke in the fetus.

STUDY DESIGN

We performed surgery on 16 fetal lambs and placed catheters in the main pulmonary artery, aorta, and left atrium to measure pressures. An ultrasonic blood flow transducer was placed around the left pulmonary artery to measure blood flow. The ewes were exposed to tobacco smoke for 2 hours. In another set of experiments, the pulmonary vascular response to increased fetal O(2) tension has been assessed after 2 hours of tobacco smoke inhalation or not (control group).

RESULTS

Exposure to tobacco smoke decreased pulmonary blood flow by 30% and elevated pulmonary vascular resistance by 40%. The vasodilator response to increased O(2) tension was blunted after smoke inhalation compared with control animals. Smoke inhalation was associated with a decrease in fetal PaO(2) and SaO(2).

CONCLUSION

Exposure to environmental tobacco smoke in pregnant ewes impairs both basal tone and vascular reactivity of the fetal lung.

The Mechanisms of Pain-Induced Pulmonary Vasoconstriction: An Experimental Study in Fetal Lambs

BACKGROUND

Nociceptive stimulation induces pulmonary vasoconstriction in fetuses and newborns. The mechanism of this response is not fully understood. As the systemic hemodynamic response to pain is mainly mediated by sympathetic stimulation, we hypothesized that pain-induced pulmonary vasoconstriction results from the activation of catecholaminergic receptors. To test this hypothesis, we studied the pulmonary vascular response to nociceptive stimuli in fetal lambs before and after alpha-adrenoceptor blockade.

METHODS

Surgery was performed in fetal lambs. Catheters were placed into the ascending aorta, superior vena cava, and main pulmonary artery. An ultrasonic flow transducer was placed around the left pulmonary artery, and subcutaneous catheters were placed in the limb. The hemodynamic responses to (1) subcutaneous injection of formalin (which is used as nociceptive stimulus in experimental studies), (2) prazosin (specific alpha(1)-adrenoceptor antagonist), and (3) formalin during prazosin infusion were evaluated. Plasma cortisol and catecholamine concentrations were measured.

RESULTS

Pulmonary vascular resistance (PVR) increased by 50% (P < 0.01) after the formalin test. PVR did not change after the formalin test during prazosin infusion or during prazosin infusion alone. Catecholamine and cortisol levels did not change during any of the protocols.

DISCUSSION

Our results indicate that the fetal pulmonary vasoconstrictive response to pain involves alpha(1)-adrenoceptors activation. As plasma catecholamine concentrations did not change after the formalin test, we speculate that the pulmonary vascular response to nociceptive stimuli could be triggered by a local release of catecholamine induced by sympathetic stimulation.