Left Ventricular Norepinephrine and Epinephrine Kinetics at Birth in Lambs

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Abstract
Little is known about the changes in the left ventricular (LV) kinetics of the catecholamines norepinephrine and epinephrine occurring at birth and their relationship to perinatal alterations in LV function and whole-body catecholamine kinetics. To address this issue, whole-body and LV catecholamine kinetics (radiotracer dilution methodology) and fetal LV output and myocardial blood flow (radioactive microspheres) were measured in chronically instrumented near-term fetuses and in the same animals 1 and 4 hours after birth. Between fetal and 1-hour lambs, LV external work increased 115% ( P <.005); carotid arterial plasma norepinephrine concentration, 148% ( P <.01); carotid arterial plasma epinephrine concentration, 546% ( P <.005); LV norepinephrine spillover, a measure of LV sympathetic activity, 4.1-fold ( P <.005); LV epinephrine spillover, 3-fold ( P <.05); total-body spillover of norepinephrine, 52% ( P <.025); and total-body spillover of epinephrine, 460% ( P <.005). Arterial catecholamine concentrations and total-body catecholamine spillovers were unchanged between 1- and 4-hour lambs, but LV external work fell ( P <.05) to a level still 77% greater than in fetal lambs ( P <.005); LV norepinephrine spillover returned to near-fetal levels, and LV epinephrine spillover became undetectable. These results suggest that (1) a transient increase in LV sympathetic activity occurs at birth and may contribute to the immediate postnatal augmentation of LV performance, (2) organ differences in the pattern of sympathetic activation occur at birth, and (3) birth-related increases in LV sympathetic activity are accompanied by release of epinephrine from the heart.