The day we are born is the most dangerous day of our lives. The transition from the protected environment in the womb to independent breathing after birth can be a major challenge, particularly for premature babies. The lungs must transition from a fluid-filled organ into an air-filled system in a very short period of time - a uniquely complex process for which premature babies require medical assistance in form of positive airway pressure. Complications during this phase can have long-term health consequences.
The research project “From EAGLE to LEOPARD” by DZL researcher Vincent Gaertner, assistant doctor at the Dr. von Hauner Children's Hospital (LMU) and principal investigator at the DZL Munich site (CPC-M), starts exactly here: Dr Gaertner wants to improve our understanding how this transition works and how premature babies can be optimally supported in the delivery room. The aim is to improve medical care in this unique and critical phase of life, thereby increasing the chances of survival and the later quality of life of newborns.
The German Research Foundation (DFG) is funding this project as an Emmy Noether Junior Research Group over a period of six years.
Understanding the first breaths after birth
The project has two main goals: on the one hand, the researchers want to improve our understanding of the natural adaptation of the lungs after birth, and on the other hand, they will test a new clinical strategy for supporting breathing in very prematurely born children.
In order to better understand the physiological mechanisms behind the first breaths after birth, the team will utilize a relatively novel and innovative method: electrical impedance tomography (EIT). This is a special chest belt with 32 electrodes that visualizes the air distribution in the lungs in real time. These measurements are taken immediately after birth for both full-term and preterm infants. This aims to answer the following central questions:
- What’s the difference between preterm and term infants with regard to the first breaths after birth?
- What’s the effect of the birth mode (cesarean section vs. natural birth) and of the time of umbilical cord clamping on the evolution of lung volumes after birth?
- How do medical interventions such as ventilation or different pressure levels affect lung volumes?
New strategies for respiratory support
The knowledge gained will be examined in a large-scale randomized clinical study. Two different pressure levels are compared for initial respiratory support of very premature children (born before the 32nd week of pregnancy) in the first ten minutes after birth. At this timepoint, the preterm lungs may benefit from a higher pressure level in order to push residual lung liquid into the interstitium and improve early lung aeration. The goal is to find out which method produces the best results. What's special: The evaluation of the success is evaluated using a novel outcome assessment which is developed together with parent representatives and which takes several outcomes into consideration and ranks them according to the perceived clinical importance to the affected families.
The project combines basic research of lung physiology with clinical application to make the start of life safer for the smallest patients.
The DFG's Emmy Noether Program gives outstandingly qualified young researchers the opportunity to qualify for a university professorship by independently leading a junior research group over a period of six years.
