The first breaths of life: imaging studies of the human infant during neonatal transition

Summary The neonatal transition during birth is characterized by major physiological changes in respiratory and hemodynamic function, which are predominantly initiated by labor, lung aeration and clamping of the umbilical cord. Lung liquid clearance and lung aeration are not only important for the establishment of functional residual capacity, but these events also trigger the significant decrease in pulmonary vascular resistance and increase in pulmonary blood flow. Clamping the umbilical cord also contributes to these hemodynamic changes by increasing the systemic vascular resistance and sudden loss of a large proportion of venous return. This results in blood flow changes both through the foramen ovale and ductus arteriosus and eventually leads to closure of these structures and the separation of the pulmonary and systemic circulations. Most of the early theories describing neonatal transition are based on imaging studies of human infants from the 1900s. Some of these theories have been disproven in more recent studies using more accurate and non-invasive imaging techniques. This review will provide an overview of the theories suggested to explain the process of liquid clearance and lung recruitment and also addresses new findings in this field of research.