Oxidative stress in the fetal lamb brain following intermittent umbilical cord occlusion: a path analysis

Objective To evaluate the relative contribution of cord occlusion length intervals between occlusions and experimental duration on oxidative stress in the fetal lamb brain. Design Acute, partially exteriorised fetal lambs with intermittent total cord occlusion. Setting The Vivarium of Westmead Hospital, University of Sydney, Australia and The Chinese University of Hong Kong. Main outcome measures Arterio‐venous differences in the concentration of organic hydroperoxides, measured in paired samples of carotid arterial and jugular venous blood, as an index of oxidative stress in the brain. Methods Thirty‐two fetal lambs were exposed to graded hypoxia, induced by intermittent total umbilical cord compression of 30 seconds, 60 seconds and 90 seconds duration, occurring every minute for a total of 27 occlusions over 81 minutes. Three sham experiments were also performed. In addition to organic hydroperoxides, carotid arterial blood samples were also assayed in 15 animals (two sham) for oxygen saturation, pH, hypoxanthine, xanthine and urate concentrations. A causal model for oxidative stress was defined: occlusions leading to hypoxia with a rise in hypoxanthine; reperfusion during intervals between occlusions leading to the accelerated production of xanthine and uric acid and the generation of oxygen free radicals, which in turn, are responsible for the rise in lipid peroxidation. Path analysis was performed to assess the strength of the relationships between these variables and the cord occlusion length, the interval between occlusions and the duration of the experiment. Results Sham experiments showed no change in organic hydroperoxide production. Following 30‐second umbilical cord occlusions a sixfold drop in mean organic hydroperoxides was observed between carotid arterial and jugular venous levels. In contrast, following occlusions of 60 seconds duration (or longer) a median 20‐fold increase in organic hydroperoxide production was observed. Path analysis revealed a strong indirect pathway from occlusion length → hypoxanthine → urate and weak positive pathways from oxygen saturation→ urate and from interval between occlusions → urate. After accounting for these pathways reflecting oxidative stress, a strong direct path remained from time from first occlusion → organic hydroperoxide production. Conclusions Peroxidation of lipids in the brain occurs under conditions of severe hypoxia and reperfusion associated with intermittent umbilical cord occlusions of 60 seconds or longer. The path analysis supported the causal model as originally defined, with the exception that the indirect pathway via pH was found to be trivial.