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Animal studies have demonstrated that acute blood loss may produce an increase in pulmonary vascular resistance. We postulate that hypovolemia may be one factor in the etiology of persistent fetal circulation (PFC). Circulating red cell volume (using 51 Cr labeling techniques) was measured in 5 neonates who presented with clinical findings of PFC (tachypnea, extra-pulmonary right-to-left shunting and normal cardiovascular anatomy at catheterization and/or autopsy).

Birth weights of the 5 infants ranged from 2420-4140 (mean 3772) grams; gestational ages were 35-41 (mean 39) weeks, and all infants had normal 5-minute Apgar scores. Blood loss was not suspected in any of the 5 infants, nor were any transfused prior to their red cell volume studies. The initial hematocrits, glucose concentrations and calcium values were ≥ 55%, ≥ 95mg/dl, and ≥ 7.8mg/dl respectively. Four of the 5 infants expired despite vigorous resuscitative efforts, including transfusion.

Red cell volume in all infants was deficient (30-42%, mean 36%). These data suggest that diminished circulating red cell volume may be involved in the etiology of persistent fetal circulation.

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Paxson, C., Clark, E. 144 HYPOVOLEMIA AND PERSISTENT FETAL CIRCULATION. Pediatr Res 12, 387 (1978).

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