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Enyinna KP, Eleje GU, Odugu BU, Nevo CO, Ofor IJ, Mbachu II, Eze CC, Okoh DS, Ikwuka DC, Awkadigwe FI, Okafor CC, Malachy DE, Ortuanya KE, Eze HT, Okoro CC, Okafor CG. Impact of early versus delayed umbilical cord clamping on term neonates' haemoglobin levels: a randomized controlled trial. J Int Med Res 2024; 52:3000605241255836. [PMID: 38851870 PMCID: PMC11162598 DOI: 10.1177/03000605241255836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/02/2024] [Indexed: 06/10/2024] Open
Abstract
OBJECTIVE To compare the effects of early and delayed cord clamping on the haemoglobin levels of neonates delivered at term. METHODS This randomized controlled trial enrolled pregnant women during the second stage of labour. They were randomized into either the early cord clamping (ECC) group or the delayed cord clamping (DCC) group in the ratio of 1:1. Following delivery of the baby, the umbilical cords of participants in the ECC group were clamped within 30 s of delivery of the neonate while those of participants in the DCC group were clamped after 2 min from the delivery of the neonate. The primary outcome measure was the effect of ECC and DCC on the haemoglobin levels of neonates delivered at term. RESULTS A total of 270 pregnant women were enrolled in the study. Their baseline sociodemographic and clinical characteristics were similar in both groups. There was no significant difference in the mean haemoglobin level between ECC and DCC groups at birth. The mean haemoglobin level of the neonates at 48 h postpartum was significantly higher in the DCC group than the ECC group. CONCLUSION DCC at birth was associated with a significant increase in neonatal haemoglobin levels at 48 h postpartum when compared with ECC.Trial Registration: The trial was registered at Pan African Clinical Trial Registry with approval number PACTR202206735622089.
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Affiliation(s)
- Kelechi P. Enyinna
- Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu State, Nigeria
| | - George U. Eleje
- Department of Obstetrics & Gynaecology, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria
| | - Boniface U. Odugu
- Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu State, Nigeria
| | - Calistus O. Nevo
- Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu State, Nigeria
| | - Ifeanyichukwu J. Ofor
- Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu State, Nigeria
| | - Ikechukwu I. Mbachu
- Department of Obstetrics & Gynaecology, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria
| | - Chukwuka C. Eze
- Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu State, Nigeria
| | - Darlington S. Okoh
- Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu State, Nigeria
| | - David C. Ikwuka
- Department of Medical Physiology, College of Medicine and Health sciences, University of Rwanda, Kigali City, Rwanda
| | - Fredrick I. Awkadigwe
- Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu State, Nigeria
| | - Chidinma C. Okafor
- Department of Psychiatry, Leicestershire Partnership NHS Trust, Leicester, United Kingdom
| | - Divinefavour E. Malachy
- Department of Obstetrics & Gynaecology, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria
| | - Kelvin E. Ortuanya
- Department of Obstetrics & Gynaecology, Enugu State University of Science and Technology (ESUT) Teaching Hospital, Parklane, Enugu State, Nigeria
| | - Hyacinth T. Eze
- Department of Internal Medicine, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria
| | - Chukwuemeka C. Okoro
- Department of Obstetrics & Gynaecology, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria
| | - Chigozie G. Okafor
- Department of Obstetrics & Gynaecology, Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State, Nigeria
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Bensouda B, Mandel R, Mejri A, Tordjman L, St-Hilaire M, Ali N. Supine versus Prone Position during Delayed Cord Clamping in Infants ≥36 Weeks: A Randomized Trial. Am J Perinatol 2024; 41:e2799-e2803. [PMID: 37726014 DOI: 10.1055/s-0043-1775563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
OBJECTIVE There is no recommendation in the literature on optimal positioning of the newborn immediately at birth during delayed cord clamping. To evaluate if prone positioning on the mother's chest at birth during delayed cord clamping leads to a higher hematocrit at 30 hours of life compared to supine positioning. STUDY DESIGN A randomized unblinded trial comparing prone and supine position of the newborn before umbilical cord clamping. Healthy newborns ≥36 weeks gestational age and born vaginally with cephalic presentation were included. The newborn was randomized to prone or supine position. Umbilical cord clamping was delayed in both groups to 1 minute after birth. The primary outcome was hematocrit at 30 hours of life. As a secondary outcome, cerebral tissue oxygenation (CrSO2) values were compared between both groups by near infrared spectroscopy. RESULTS There was no difference in hematocrit at 30 hours of life between supine and prone positions with a mean at 52 and 53.1, respectively, mean difference -1.1 (95% confidence interval:-2.7, 0.5), p = 0.17. Newborns in supine and prone positions had comparable level of CrSO2 at 30 hours of life with a mean at 84.1 and 82.2, respectively, mean difference 1.9 (-0.2, 4.0), p = 0.07. There was no correlation between hematocrit and CrSO2 at 30 hours of life (r = 0.14). CONCLUSION There was no difference between prone and supine positioning immediately after birth during delayed cord clamping on hematocrit at 30 hours of life. In the absence of clear findings, further studies with assessment of the effect of position on breastfeeding success in the case room, on maternal satisfaction and outcome beyond 30 hours are needed to make adequate recommendations on positioning. KEY POINTS · Delayed cord clamping at 60 seconds is recommended at birth, but optimal positioning is unknown.. · A randomized trial was conducted to compare hematocrit at 36 hours of life of prone versus supine position.. · No difference in hematocrit was found in prone versus supine position during delayed cord clamping..
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Affiliation(s)
- Brahim Bensouda
- Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
| | - Romain Mandel
- Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
| | - Abdelwaheb Mejri
- Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
| | - Laurent Tordjman
- Department of Obstetrics and Gynecology, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
| | - Marie St-Hilaire
- Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
| | - Nabeel Ali
- Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
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Chioma R, Finn D, Healy DB, Herlihy I, Livingstone V, Panaviene J, Dempsey EM. Impact of cord clamping on haemodynamic transition in term newborn infants. Arch Dis Child Fetal Neonatal Ed 2024; 109:287-293. [PMID: 38071517 DOI: 10.1136/archdischild-2023-325652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/27/2023] [Indexed: 04/20/2024]
Abstract
OBJECTIVE To assess the haemodynamic consequences of cord clamping (CC) in healthy term infants. DESIGN Cohort study. SETTING Tertiary maternity hospital. PATIENTS 46 full-term vigorous infants born by caesarean section. INTERVENTIONS Echocardiography was performed before CC, immediately after CC and at 5 min after birth. MAIN OUTCOME MEASURES Pulsed wave Doppler-derived cardiac output and the pulmonary artery acceleration time indexed to the right ventricle ejection time were obtained. As markers of loading fluctuations, the myocardial performance indexes and the velocities of the tricuspid and mitral valve annuli were determined with tissue Doppler imaging. Heart rate was derived from Doppler imaging throughout the assessments. RESULTS Left ventricular output increased throughout the first minutes after birth (mean (SD) 222.4 (32.5) mL/kg/min before CC vs 239.7 (33.6) mL/kg/min at 5 min, p=0.01), while right ventricular output decreased (306.5 (48.2) mL/kg/min before vs 272.8 (55.5) mL/kg/min immediately after CC, p=0.001). The loading conditions of both ventricles were transiently impaired by CC, recovering at 5 min. Heart rate progressively decreased after birth, following a linear trend temporarily increased by CC. The variation in left ventricular output across the CC was directly correlated to the fluctuation of left ventricular preload over the same period (p=0.03). CONCLUSIONS This study illustrates the cardiovascular consequences of CC in term vigorous infants and offers insight into the haemodynamic transition from fetal to neonatal circulation in spontaneously breathing newborns. Strategies that aim to enhance left ventricular preload before CC may prevent complications of perinatal cardiovascular imbalance.
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Affiliation(s)
- Roberto Chioma
- University College Cork, INFANT Research Centre, Cork, Ireland
- Università Cattolica del Sacro Cuore, Roma, Italy
| | - Daragh Finn
- University College Cork, INFANT Research Centre, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - David B Healy
- University College Cork, INFANT Research Centre, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Ita Herlihy
- University College Cork, INFANT Research Centre, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Vicki Livingstone
- University College Cork, INFANT Research Centre, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Jurate Panaviene
- University College Cork, INFANT Research Centre, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Eugene M Dempsey
- University College Cork, INFANT Research Centre, Cork, Ireland
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
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de Preud'homme d'Hailly de Nieuport SMI, Krijgh EJC, Pruijssers B, Visser J, van Beek RHT. Delayed cord clamping vs cord milking in elective cesarean delivery at term: a randomized controlled trial. Am J Obstet Gynecol MFM 2024; 6:101279. [PMID: 38232817 DOI: 10.1016/j.ajogmf.2024.101279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 01/08/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND Delayed cord clamping has significant beneficial effects on the neonate and its transition to extrauterine life and, therefore, is common practice at vaginal births in the Netherlands. In 2015, 16% of neonates were born via cesarean delivery; moreover, in 81% of these cases, the umbilical cord was clamped and cut immediately. Neonatal benefits of delayed cord clamping are an increased circulating volume of 25 to 30 mL/kg, leading to a higher preload of both the right and left ventricles during the transition from umbilical circulation to pulmonary circulation, thus maintaining a stable left ventricle output, and to higher neonatal hemoglobin and hematocrit levels 24 to 48 hours after birth. Currently, little is known about whether the abovementioned neonatal benefits of delayed cord clamping could apply to neonates delivered by cesarean delivery. In these cases, possible negative effects on neonatal outcomes (ie, neonatal hypothermia, lower Apgar scores, and hyperbilirubinemia) and maternal outcomes (ie, increased maternal blood loss and higher postoperative infection rate) should also be taken into consideration. OBJECTIVE This study aimed to determine whether clamping the umbilical cord after 2 minutes is superior to cord milking during elective cesarean deliveries at term, taking both short- and long-term neonatal and maternal outcomes into consideration, and to determine whether cord milking could be an appropriate alternative to delayed cord clamping. STUDY DESIGN A randomized controlled trial was conducted in a large secondary care center in the Netherlands (Amphia Hospital in Breda) from October 2020 to April 2022. A total of 115 patients who underwent an elective cesarean delivery between 37 0/7 and 41 6/7 weeks of gestation were included. The primary outcomes were neonatal hemoglobin and hematocrit levels at 48 hours after birth. The secondary outcomes were divided into neonatal and maternal outcomes. RESULTS After randomization, 58 participants were treated with cord milking, and 57 participants were treated with delayed cord clamping. There was no significant difference in demographic characteristics between both groups. There was no significant difference in the primary outcomes, with a mean hemoglobin level 48 hours after birth of 12.1 mmol/L in the delayed cord clamping group and 12.2 mmol/L in the cord milking group (P=.80). Regarding our secondary outcomes, there was no significant difference regarding Apgar score, neonatal body temperature, maternal blood loss, and postoperative infection rate between our intervention groups. CONCLUSION Hemoglobin and hematocrit levels at 48 hours after birth showed no significant difference when comparing delayed cord clamping with cord milking. Delayed cord clamping did not lead to increased maternal blood loss or postoperative infections compared with a method with a much shorter timeframe between delivery and clamping of the umbilical cord, namely, cord milking. In addition, delayed cord clamping did not lead to a lower Apgar score or neonatal temperature compared with cord milking. Our research suggests that delayed cord clamping can be safely performed during elective cesarean deliveries at term. If intraoperative circumstances do not allow for delayed cord clamping, cord milking can be an appropriate alternative for the neonate at term.
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Affiliation(s)
| | - Eldin J C Krijgh
- Pediatrics (Drs Krijgh and van Beek), Amphia Hospital, Breda, The Netherlands
| | - Bente Pruijssers
- Departments of Obstetrics and Gynecology (Drs de Preud'homme, Pruijssers, and Visser)
| | - Jantien Visser
- Departments of Obstetrics and Gynecology (Drs de Preud'homme, Pruijssers, and Visser)
| | - Ron H T van Beek
- Pediatrics (Drs Krijgh and van Beek), Amphia Hospital, Breda, The Netherlands
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Zhu T, Shi Y. [Interpretation of 2023 American Heart Association and American Academy of Pediatrics focused update on neonatal resuscitation guidelines]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:25-30. [PMID: 38269455 PMCID: PMC10817739 DOI: 10.7499/j.issn.1008-8830.2311107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/08/2023] [Indexed: 01/26/2024]
Abstract
In November 2023, the American Heart Association and the American Academy of Pediatrics jointly released key updates to the neonatal resuscitation guidelines based on new clinical evidence. This update serves as an important supplement to the "Neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care". The aim of this paper is to outline the key updates and provide guidance on umbilical cord management and the selection of positive pressure ventilation equipment and its additional interfaces in neonatal resuscitation.
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Affiliation(s)
- Tian Zhu
- Department of Neonatology, Children's Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China (Shi Y, . cn)
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Yamada NK, Szyld E, Strand ML, Finan E, Illuzzi JL, Kamath-Rayne BD, Kapadia VS, Niermeyer S, Schmölzer GM, Williams A, Weiner GM, Wyckoff MH, Lee HC. 2023 American Heart Association and American Academy of Pediatrics Focused Update on Neonatal Resuscitation: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2024; 149:e157-e166. [PMID: 37970724 DOI: 10.1161/cir.0000000000001181] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
This 2023 focused update to the neonatal resuscitation guidelines is based on 4 systematic reviews recently completed under the direction of the International Liaison Committee on Resuscitation Neonatal Life Support Task Force. Systematic reviewers and content experts from this task force performed comprehensive reviews of the scientific literature on umbilical cord management in preterm, late preterm, and term newborn infants, and the optimal devices and interfaces used for administering positive-pressure ventilation during resuscitation of newborn infants. These recommendations provide new guidance on the use of intact umbilical cord milking, device selection for administering positive-pressure ventilation, and an additional primary interface for administering positive-pressure ventilation.
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Yeaman F, Stritzke A, Kuret V, Sharifi N, Seow CH, Metcalfe A, Leung Y. Thiopurine Exposure During Pregnancy is Not Associated With Anemia in Infants Born to Mothers With IBD. CROHN'S & COLITIS 360 2023; 5:otad066. [PMID: 37941596 PMCID: PMC10629965 DOI: 10.1093/crocol/otad066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Indexed: 11/10/2023] Open
Abstract
Background Thiopurines are commonly used to treat inflammatory bowel disease (IBD). Thiopurines are considered safe throughout pregnancy. However, a published study suggested the risk of neonatal anemia was increased if exposed to thiopurines in utero. This prospective cohort study aimed to determine if there is an increased risk of cytopenia among infants born to pregnant people with IBD, exposed or unexposed to thiopurines, compared to infants born to those without IBD. Methods Pregnant IBD patients, with and without thiopurine exposure, and one cohort of control individuals were recruited over a 5-year period. Consenting individuals completed a questionnaire and infants had a complete blood cell count at the newborn heel prick. Anemia was defined as hemoglobin (Hb) < 140g/L. Descriptive statistics were used to characterize the study population. Fisher exact tests were used to examine differences in outcomes between groups, a P-value of < 0.05 was deemed significant. Results Three cohorts were recruited: 19 IBD patients on thiopurines, 50 IBD patients not on thiopurines, and 37 controls (total of 106). Neonatal median Hb was not different with 177g/L (IQR 38g/L) for the IBD thiopurine group, 180.5g/L (IQR 40g/L) for the IBD non-thiopurine group, and 181g/L (IQR 37g/L) for the controls. Nineteen infants (18%) were cytopenic with 12 (11%) anemic, 6 (5.6%) thrombocytopenic, and 1 (0.94%) lymphopenic. Thiopurine exposure was only in one, mildly anemic, infant. Conclusions These findings further support physicians and IBD patients contemplating pregnancy that current guidelines recommending thiopurine adherence do not lead to increased perinatal risk of anemia or cytopenia.
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Affiliation(s)
- Fiona Yeaman
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Internal Medicine, University of Western Australia, Perth, WA, Australia
| | - Amelie Stritzke
- Department of Pediatrics University of Calgary, Calgary, AB, Canada
| | - Verena Kuret
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
| | - Nastaran Sharifi
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Cynthia H Seow
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences; University of Calgary, Calgary, AB, Canada
| | - Amy Metcalfe
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences; University of Calgary, Calgary, AB, Canada
| | - Yvette Leung
- Department of Medicine and Division of Gastroenterology, University of British Columbia, Vancouver, BC, Canada
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Hosny TA, Azzam AZ, Said MA, Hammad BS. Comparing delayed cord clamping and umbilical cord milking during elective cesarean section for the neonatal outcome. Eur J Obstet Gynecol Reprod Biol X 2023; 18:100200. [PMID: 37305179 PMCID: PMC10250567 DOI: 10.1016/j.eurox.2023.100200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023] Open
Abstract
Objectives to compare between immediate cord clamping, delayed cord clamping, and umbilical cord milking and their effects on hemoglobin and bilirubin level in term infants in cesarean section. Study design A randomized clinical trial was conducted from November 2021 to June 2022, including 162 full term pregnant women undergoing elective cesarean section at EL-Shatby Maternity University Hospital. They were randomly assigned (1:1:1 ratio) either to immediate cord clamping just after delivery (Group 1) or delayed cord clamping for 30 s (Group 2) or umbilical cord milking 10 times for 10-15 s (Group 3). The primary outcome measures included hemoglobin and hematocrit levels of the newborn at birth and the secondary outcome was bilirubin level measurement at 72 h of life. Results one hundred sixty- two newborns were randomized into 3 groups, fifty-four cases in each, and were investigated on hemoglobin and hematocrit levels; five were lost to follow-up and one hundred fifty-seven were tested for bilirubin. Participants among groups had no significant difference regarding demographic and clinical characteristics, regarding the hemoglobin at birth it was significant higher in the umbilical cord milking group (Group 3) through all groups (14.91 ± 0.91 g/dl vs15.38 ± 0.74 g/dl vs 16.56 ± 1.03 g/dl, p value <0.001), regarding hematocrit level at birth it was significant in the umbilical cord milking group (Group 3) through all groups (44.71 ± 2.94 vs 46.48 ± 2.61 vs 49.74 ± 3.26, p value <0.001). On the other hand, bilirubin level after 72 h had no significant different through the 3 groups (8.80(IQR 4.50-17.20), vs 9.70(IQR3.50-14.70), vs 8.50(IQR 3.20-19.50), respectively p value= 0.348). Conclusion this study showed that umbilical cord milking 10 times for 10-15 s is more effective than delayed cord clamping for 30 s in enhancing hemoglobin and hematocrit levels in newborn delivered by cesarean section with no significant difference on bilirubin level in the newborn.
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Affiliation(s)
- Tamer A. Hosny
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Egypt
| | - Amal Z. Azzam
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Egypt
| | - Mohga Ashraf Said
- Department of Obstetrics and Gynecology, Faculty of Medicine, Alexandria University, Egypt
| | - Bahaa Salah Hammad
- Department of Pediatrics and Neonatology, Faculty of Medicine, Alexandria University, Egypt
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Fite EL, Rivera BK, McNabb R, Smith CV, Hill KD, Katheria A, Maitre N, Backes CH. Umbilical cord clamping among infants with a prenatal diagnosis of congenital heart disease. Semin Perinatol 2023; 47:151747. [PMID: 37002126 DOI: 10.1016/j.semperi.2023.151747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Elliott L Fite
- Ohio Perinatal Research Network (OPRN), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Brian K Rivera
- Ohio Perinatal Research Network (OPRN), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Riley McNabb
- Ohio Perinatal Research Network (OPRN), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Charles V Smith
- Center for Integrated Brain Research, Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, WA, USA
| | - Kevin D Hill
- Duke University Pediatric and Congenital Heart Center, Durham, NC, USA; Duke Clinical Research Institute, Durham, NC, USA
| | - Anup Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, USA
| | - Nathalie Maitre
- Emory University School of Medicine, Atlanta, GA, USA; Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Carl H Backes
- Ohio Perinatal Research Network (OPRN), The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA; Departments of Pediatrics and Obstetrics & Gynecology, The Ohio State University, Columbus, OH, USA.
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10
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Andersson O, Zaigham M. Cord clamping - 'hold on a minute' is not enough, and sample your blood gases while waiting. Semin Perinatol 2023; 47:151739. [PMID: 37002124 DOI: 10.1016/j.semperi.2023.151739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
There is confusion regarding the dynamics of the umbilical cord circulation and the concomitant placental transfusion. How long does it continue, and at what rate? These questions remain an enigma for many. In this article we will address some common misconceptions about the management of cord circulation, try to explain why there is a lack of clarity, and call in to question the conclusions from an influential meta-analysis and a recently published guideline on cord clamping. We will do that partly by reviewing the rather extensive literature published on the subject over the past 50 to 70 years, which is easily forgotten, but worth considering. In this review, we will also address the important subject of why and how to sample cord blood correctly and to interpret umbilical gases with a sustained cord circulation, which is a crucial part of our ongoing multicenter study 'Sustained cord circulation And Ventilation', the SAVE-study.
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Affiliation(s)
- Ola Andersson
- Department of Clinical Sciences Lund, SUS, Barn-Ungdomssjukh. Avd. Ped., Lund University, Lund 221 85, Sweden; Department of Pediatric Surgery and Neonatology, Skåne University Hospital, Sweden.
| | - Mehreen Zaigham
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Malmö, Sweden; Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA
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Murali M, Sethuraman G, Vasudevan J, Umadevi L, Devi U. Delayed cord clamping versus cord milking in vigorous neonates ≥35 weeks gestation born via cesarean: A Randomized clinical trial. J Neonatal Perinatal Med 2023; 16:597-603. [PMID: 38007676 DOI: 10.3233/npm-230069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
BACKGROUND Delayed cord clamping (DCC) is the recommended strategy in neonates not requiring resuscitation, but umbilical cord milking (UCM) can also be used in term babies. DCC has been found to offer advantages more than just placental transfusion. OBJECTIVE To compare the neonatal outcomes of DCC and UCM at birth in vigorous neonates ≥35 weeks born via cesarean section. METHODS We included all vigorous neonates born ≥35 weeks of gestation through the cesarean section in this open-label randomized controlled trial. They were randomized into Group-A (DCC-cord was clamped 60 s after birth) or Group B(UCM). For neonates in Group B, the intact cord was milked at 25 cm from the stump 3 times towards the neonate and then clamped. The primary outcome was hematocrit at 72 h of life. Secondary outcomes were serum ferritin between 6 and 10 weeks of life, serum bilirubin at 72 h of life, need and duration of phototherapy, respiratory distress, hypoglycemia, hypotension, and sepsis. RESULTS Baseline characteristics were similar in both the groups. The mean hematocrit at 72 h was more in the DCC group compared to the UCM group [(55.60±4.50) vs (53.89±4.44), MD (95% CI) = 1.71 (0.26, 3.16); p = 0.021]. There was no significant difference in median serum ferritin between the groups [102.88(84.67-173.24) vs 137.93(85.15-230.40); p = 0.173]. There was no significant difference in clinical outcomes. CONCLUSION In neonates born via cesarean section, DCC resulted in improved hematocrit levels by 72 hours compared to UCM. DCC results in better placental transfusion.
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Affiliation(s)
- Mithuna Murali
- Department of Pediatrics, Chettinad Hospital & Research Institute, Kelambakkam, Kanchipuram, Tamilnadu, India
| | - Giridhar Sethuraman
- Department of Neonatology, Chettinad Hospital & Research Institute, Kelambakkam, Kanchipuram, Tamilnadu, India
| | - Jaishree Vasudevan
- Department of Pediatrics, Chettinad Hospital & Research Institute, Kelambakkam, Kanchipuram, Tamilnadu, India
| | - L Umadevi
- Department of Pediatrics, Chettinad Hospital & Research Institute, Kelambakkam, Kanchipuram, Tamilnadu, India
| | - Usha Devi
- Department of Neonatology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Wanous AA, Ibrahim J, Vats KR. Neonatal resuscitation. Semin Pediatr Surg 2022; 31:151204. [PMID: 36038213 DOI: 10.1016/j.sempedsurg.2022.151204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Amanda A Wanous
- Division of Newborn Medicine, Department of Pediatrics, Children and Magee Women's Hospital, University of Pittsburgh, 300 Halket Street, PA 12513, United States
| | - John Ibrahim
- Division of Newborn Medicine, Department of Pediatrics, Children and Magee Women's Hospital, University of Pittsburgh, 300 Halket Street, PA 12513, United States
| | - Kalyani R Vats
- Division of Newborn Medicine, Department of Pediatrics, Children and Magee Women's Hospital, University of Pittsburgh, 300 Halket Street, PA 12513, United States.
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Ott F, Kribs A, Stelzl P, Kyvernitakis I, Ehlen M, Schmidtke S, Rawnaq-Möllers T, Rath W, Berger R, Maul H. Resuscitation of Term Compromised and Asphyctic Newborns: Better with Intact Umbilical Cord? Geburtshilfe Frauenheilkd 2022; 82:706-718. [PMID: 35815099 PMCID: PMC9262631 DOI: 10.1055/a-1804-3268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/18/2022] [Indexed: 10/27/2022] Open
Abstract
AbstractThe authors hypothesize that particularly severely compromised and asphyctic term infants in need of resuscitation may benefit from delayed umbilical cord clamping (after several minutes).
Although evidence is sparse, the underlying pathophysiological mechanisms support this assumption. For this review the authors have analyzed the available research. Based on these data they
conclude that it may be unfavorable to immediately clamp the cord of asphyctic newborns (e.g., after shoulder dystocia) although recommended in current guidelines to provide quick
neonatological support. Compression of the umbilical cord or thorax obstructs venous flow to the fetus more than arterial flow to the placenta. The fetus is consequently cut off from a
supply of oxygenated, venous blood. This may cause not only hypoxemia and consecutive hypoxia during delivery but possibly also hypovolemia. Immediate cord clamping may aggravate the
situation of the already compromised newborn, particularly if the cord is cut before the lungs are ventilated. By contrast, delayed cord clamping leads to fetoplacental transfusion of
oxygenated venous blood, which may buffer an existing acidosis. Furthermore, it may enhance blood volume by up to 20%, leading to higher levels of various blood components, such as red and
white blood cells, thrombocytes, mesenchymal stem cells, immunoglobulins, and iron. In addition, the resulting increase in pulmonary perfusion may compensate for an existing hypoxemia or
hypoxia. Early cord clamping before lung perfusion reduces the preload of the left ventricle and hinders the establishment of sufficient circulation. Animal models and clinical trials
support this opinion. The authors raise the question whether it would be better to resuscitate compromised newborns with intact umbilical cords. Obstetric and neonatal teams need to work
even closer together to improve neonatal outcomes.
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Affiliation(s)
- Friederike Ott
- Frauenkliniken der Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Hamburg, Germany
- Asklepios Medical School, Hamburg, Germany
| | - Angela Kribs
- Klinik für Neonatologie und pädiatrische Intensivmedizin, Universitätskinderklinik, Köln, Germany
| | - Patrick Stelzl
- Frauenklinik, Kepler Universitätsklinikum Linz, Linz, Austria
| | - Ioannis Kyvernitakis
- Frauenkliniken der Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Hamburg, Germany
| | - Michael Ehlen
- Klinik für Kinder- und Jugendmedizin, Marienhaus Klinikum Bendorf – Neuwied – Waldbreitbach, Neuwied, Germany
| | - Susanne Schmidtke
- Klinik für Neonatologie und pädiatrische Intensivmedizin, Asklepios Kliniken Barmbek und Nord-Heidberg, Hamburg, Germany
| | - Tamina Rawnaq-Möllers
- Frauenkliniken der Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Hamburg, Germany
| | - Werner Rath
- Universitätsfrauenklinik, Universitätsklinikum Schleswig Holstein, Kiel, Germany
| | - Richard Berger
- Frauenklinik, Marienhaus Klinikum Neuwied, Neuwied, Germany
| | - Holger Maul
- Frauenkliniken der Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Hamburg, Germany
- Asklepios Medical School, Hamburg, Germany
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McDonald SD, Narvey M, Ehman W, Jain V, Cassell K. Guideline No. 424: Umbilical Cord Management in Preterm and Term Infants. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:313-322.e1. [PMID: 35300830 DOI: 10.1016/j.jogc.2022.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the impact of deferred (delayed) cord clamping (DCC) and umbilical cord milking in singleton and twin gestations on maternal and infant mortality and morbidity. TARGET POPULATION People who are pregnant with preterm or term singletons or twins. BENEFITS, HARMS, AND COSTS In preterm singletons, DCC for (ideally) 60 to 120 seconds, but at least for 30 seconds, reduces infant risk of mortality and morbidity. DCC in preterm twins is associated with some benefits. In term singletons, DCC for 60 seconds improves hematological parameters. In very preterm infants, umbilical cord milking increases risk for intraventricular hemorrhage. EVIDENCE Searches of Medline, PubMed, Embase, and the Cochrane Library from inception to March 2020 were undertaken using Medical Subject Heading (MeSH) terms and key words related to deferred cord clamping and umbilical cord milking. This document represents an abstraction of the evidence rather than a methodological review. VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations). INTENDED USERS Maternity and newborn care providers. RECOMMENDATIONS
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McDonald SD, Narvey M, Ehman W, Jain V, Cassell K. Directive clinique no 424 : Prise en charge du cordon ombilical chez le nourrisson prématuré ou à terme. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2022; 44:323-333.e1. [DOI: 10.1016/j.jogc.2022.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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16
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Itoh S, Okada H, Koyano K, Nakamura S, Konishi Y, Iwase T, Kusaka T. Fetal and neonatal bilirubin metabolism. Front Pediatr 2022; 10:1002408. [PMID: 36824297 PMCID: PMC9941200 DOI: 10.3389/fped.2022.1002408] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 12/30/2022] [Indexed: 02/10/2023] Open
Abstract
Human fetal and neonatal bilirubin metabolism is centered on 4Z,15Z-bilirubin IXα (BR) due to the extremely low BR conjugating capacity of the liver. BR is a unique, highly lipophilic substance with physiological and toxic effects in the cell membranes of organs and body tissues. The fetus excretes BR through the placenta to the maternal circulation. After birth, BR is thought to act as an antioxidant against the increase in reactive oxygen species caused by the rapid increase in oxygen concentration during the adaptation process from in amniotic fluid to in air. However, bilirubin encephalopathy is a toxic effect of bilirubin. Due to the lipophilic nature of BR, it must be bound to a carrier to be distributed to various parts of the body by hydrophilic blood. This carrier of BR is human serum albumin (HSA). In humans, BR can be excreted efficiently after undergoing photochemical reactions upon high affinity binding to HSA. HSA also plays an important role in the prevention of bilirubin encephalopathy. This review focuses on the developmental and physiological role of bilirubin metabolism during the fetal and neonatal periods.
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Affiliation(s)
- Susumu Itoh
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Hitoshi Okada
- Division of Analytical Technology, Department of Medical Technology, Kagawa Prefectural University of Health Sciences, Kagawa, Japan
| | - Kosuke Koyano
- Maternal Perinatal Center, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Shinji Nakamura
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yukihiko Konishi
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takashi Iwase
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Takashi Kusaka
- Department of Pediatrics, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D, Bhanji F, Andersen LW, Avis SR, Aziz K, Bendall JC, Berry DC, Borra V, Böttiger BW, Bradley R, Bray JE, Breckwoldt J, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Davis PG, de Almeida MF, de Caen AR, de Paiva EF, Deakin CD, Djärv T, Douma MJ, Drennan IR, Duff JP, Eastwood KJ, El-Naggar W, Epstein JL, Escalante R, Fabres JG, Fawke J, Finn JC, Foglia EE, Folke F, Freeman K, Gilfoyle E, Goolsby CA, Grove A, Guinsburg R, Hatanaka T, Hazinski MF, Heriot GS, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hung KKC, Hsu CH, Ikeyama T, Isayama T, Kapadia VS, Kawakami MD, Kim HS, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lockey AS, Malta Hansen C, Markenson D, Matsuyama T, McKinlay CJD, Mehrabian A, Merchant RM, Meyran D, Morley PT, Morrison LJ, Nation KJ, Nemeth M, Neumar RW, Nicholson T, Niermeyer S, Nikolaou N, Nishiyama C, O'Neil BJ, Orkin AM, Osemeke O, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Sawyer T, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Smyth MA, Soll RF, Sugiura T, Taylor-Phillips S, Trevisanuto D, Vaillancourt C, Wang TL, Weiner GM, Welsford M, Wigginton J, Wyllie JP, Yeung J, Nolan JP, Berg KM. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Neonatal Life Support; Education, Implementation, and Teams; First Aid Task Forces; and the COVID-19 Working Group. Circulation 2021; 145:e645-e721. [PMID: 34813356 DOI: 10.1161/cir.0000000000001017] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.
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Wyckoff MH, Singletary EM, Soar J, Olasveengen TM, Greif R, Liley HG, Zideman D, Bhanji F, Andersen LW, Avis SR, Aziz K, Bendall JC, Berry DC, Borra V, Böttiger BW, Bradley R, Bray JE, Breckwoldt J, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Costa-Nobre DT, Couper K, Dainty KN, Davis PG, de Almeida MF, de Caen AR, de Paiva EF, Deakin CD, Djärv T, Douma MJ, Drennan IR, Duff JP, Eastwood KJ, Epstein JL, Escalante R, Fabres JG, Fawke J, Finn JC, Foglia EE, Folke F, Freeman K, Gilfoyle E, Goolsby CA, Grove A, Guinsburg R, Hatanaka T, Hazinski MF, Heriot GS, Hirsch KG, Holmberg MJ, Hosono S, Hsieh MJ, Hung KKC, Hsu CH, Ikeyama T, Isayama T, Kapadia VS, Kawakami M, Kim HS, Kloeck DA, Kudenchuk PJ, Lagina AT, Lauridsen KG, Lavonas EJ, Lockey AS, Malta Hansen C, Markenson D, Matsuyama T, McKinlay CJD, Mehrabian A, Merchant RM, Meyran D, Morley PT, Morrison LJ, Nation KJ, Nemeth M, Neumar RW, Nicholson T, Niermeyer S, Nikolaou N, Nishiyama C, O'Neil BJ, Orkin AM, Osemeke O, Parr MJ, Patocka C, Pellegrino JL, Perkins GD, Perlman JM, Rabi Y, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Sawyer T, Schmölzer GM, Schnaubelt S, Semeraro F, Skrifvars MB, Smith CM, Smyth MA, Soll RF, Sugiura T, Taylor-Phillips S, Trevisanuto D, Vaillancourt C, Wang TL, Weiner GM, Welsford M, Wigginton J, Wyllie JP, Yeung J, Nolan JP, Berg KM. 2021 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2021; 169:229-311. [PMID: 34933747 PMCID: PMC8581280 DOI: 10.1016/j.resuscitation.2021.10.040] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The International Liaison Committee on Resuscitation initiated a continuous review of new, peer-reviewed published cardiopulmonary resuscitation science. This is the fifth annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations; a more comprehensive review was done in 2020. This latest summary addresses the most recently published resuscitation evidence reviewed by International Liaison Committee on Resuscitation task force science experts. Topics covered by systematic reviews in this summary include resuscitation topics of video-based dispatch systems; head-up cardiopulmonary resuscitation; early coronary angiography after return of spontaneous circulation; cardiopulmonary resuscitation in the prone patient; cord management at birth for preterm and term infants; devices for administering positive-pressure ventilation at birth; family presence during neonatal resuscitation; self-directed, digitally based basic life support education and training in adults and children; coronavirus disease 2019 infection risk to rescuers from patients in cardiac arrest; and first aid topics, including cooling with water for thermal burns, oral rehydration for exertional dehydration, pediatric tourniquet use, and methods of tick removal. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, according to the Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations or good practice statements. Insights into the deliberations of the task forces are provided in Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces listed priority knowledge gaps for further research.
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Pauley AN, Roy A, Balfaqih Y, Casey E, Marteney R, Evans JE. A Quality Improvement Project to Delay Umbilical Cord Clamping Time. Pediatr Qual Saf 2021; 6:e452. [PMID: 35018311 PMCID: PMC8741268 DOI: 10.1097/pq9.0000000000000452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 03/03/2021] [Indexed: 12/03/2022] Open
Abstract
Delayed cord clamping (DCC) has numerous benefits to the neonate, including increased hemoglobin levels, decreased need for red blood cell transfusions, and decreased incidence of necrotizing enterocolitis and intraventricular hemorrhage. A preliminary observational study at our institution demonstrated 12% of the observed deliveries met the DCC standard, defined as umbilical cord clamping at least 30-60 seconds after birth. Therefore, we designed a quality improvement project to increase the percentage of deliveries using DCC. METHODS We planned a quality improvement project aiming to increase DCC rates on the university obstetrics service. Our interventions included provider education, installation of timers in the delivery suites, and modification to documentation in the electronic health record. We measured our results through the documented status of cord clamping, either: (1) greater than or equal to 30 seconds or (2) less than 30 seconds. We analyzed the DCC rates weekly and compared those results to the DCC goal of 80% of all deliveries. RESULTS Postintervention DCC rates were 96% overall. Rates of DCC met our aim of 80% or greater each of the 6 weeks we collected data. CONCLUSION Simple and inexpensive interventions quickly led to improvements in DCC rates on our university obstetrics service. Our interventions including, provider education, installation of timers in delivery suites, and modification to cord clamping documentation in the electronic health record can be easily instituted at other hospitals. Additionally, the simplicity of this system can produce long-term sustainability of DCC.
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Affiliation(s)
- Amanda N. Pauley
- From the Department of Obstetrics and Gynecology, Joan C Edwards School of Medicine, Marshall University, Huntington, W.Va
| | - Amy Roy
- From the Department of Obstetrics and Gynecology, Joan C Edwards School of Medicine, Marshall University, Huntington, W.Va
| | - Yaslam Balfaqih
- Department of Pediatrics, Joan C Edwards School of Medicine, Marshall University, Huntington, W.Va
| | - Erin Casey
- Joan C Edwards School of Medicine, Marshall University, Huntington, W.Va
| | - Rachel Marteney
- Joan C Edwards School of Medicine, Marshall University, Huntington, W.Va
| | - Joseph E. Evans
- Department of Pediatrics, Joan C Edwards School of Medicine, Marshall University, Huntington, W.Va
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Katariya D, Swain D, Singh S, Satapathy A. The Effect of Different Timings of Delayed Cord Clamping of Term Infants on Maternal and Newborn Outcomes in Normal Vaginal Deliveries. Cureus 2021; 13:e17169. [PMID: 34532192 PMCID: PMC8436003 DOI: 10.7759/cureus.17169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 11/05/2022] Open
Abstract
Background and objective Delayed cord clamping (DCC) has proven to be an ideal approach to reduce iron deficiency anemia; however, different timings of DCC relative to the birth outcome lead to conflicting results. The present study was conducted to determine the effects of different timings of DCC on the maternal and neonatal outcomes in normal vaginal deliveries at term. Methods This was an interventional study on neonates born at term without complications to mothers with uneventful pregnancies in the labor unit of a district hospital in Odisha, India. A total of 147 women were randomized to three intervention groups: DCC at one minute, DCC at two minutes, and DCC at three minutes. Hemoglobin and bilirubin levels, maternal blood loss, the timing of the third stage of labor, oxytocin use, and birth weight of the neonates were measured as the outcomes of different timings of DCC. Results At 24-48 hours of age, hemoglobin and bilirubin levels of the neonates were significantly higher with DCC at three minutes compared to DCC at one and two minutes. However, there were no significant differences among the three groups in terms of the need for phototherapy. The duration of the third stage of labor was significantly longer with DCC at three minutes. Maternal blood loss, oxytocin use, and birth weight of the neonates were not significantly associated with the timing of DCC. Conclusion Based on our findings, waiting to clamp the umbilical cord until three minutes can effectively reduce the incidence of iron deficiency anemia in newborns.
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Affiliation(s)
- Divya Katariya
- College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Dharitri Swain
- Obstetrics and Gynaecology Nursing, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Sweta Singh
- Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhubaneswar, Bhubaneswar, IND
| | - Arti Satapathy
- Obstetrics and Gynaecology, District Hospital Khurda, Khurda, IND
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21
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Shao H, Gao S, Lu Q, Zhao X, Hua Y, Wang X. Effects of delayed cord clamping on neonatal jaundice, phototherapy and early hematological status in term cesarean section. Ital J Pediatr 2021; 47:115. [PMID: 34039384 PMCID: PMC8157738 DOI: 10.1186/s13052-021-01069-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Delayed cord clamping in full-term neonates is widely recommended, while in practice, it is rarely implemented in cesarean section due to the fear of neonatal jaundice and excessive maternal blood loss. The optimal timing of cord clamping remains uncertain. This study was to fully evaluate the effects of delayed cord clamping on short-term hematological status and jaundice in term neonates delivered by cesarean section. Methods This retrospective study enrolled 796 women, who were allocated into the early cord clamping group (n = 377) and the delayed cord clamping group (n = 419). The latter group was further divided into two subgroups (30–60 s, 61–120 s). The outcomes were neonatal transcutaneous bilirubin levels on 0 to 5 days of life and the rate of phototherapy. For neonates who had blood tests on the first three days of life, their hemoglobin and hematocrit were compared among groups. Results Compared with the early cord clamping group, delayed cord clamping merely increased the transcutaneous bilirubin level of neonates on the day of birth rather than that on the following five days. The heel peripheral blood sample size of 1–3 days in the early cord clamping group was 61, 25 and 33, and in the delayed cord clamping group was 53, 46 and 32, respectively. Delayed cord clamping at 30–60 s resulted in the higher neonatal hemoglobin level on day 3 and an increased rate of neonatal polycythemia, without a higher rate of phototherapy. Delayed cord clamping beyond 60 s did not further improve hematological status in term neonates born by cesarean section. Conclusion In cesarean section, delayed cord clamping for 30–60 s improved the early hematological status of term neonates without the enhanced requirement of phototherapy for neonatal jaundice.
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Affiliation(s)
- Hailing Shao
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Shichu Gao
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Qiujing Lu
- Department of Obstetrics and Gynecology, Jiaxing Xiuzhou District Maternal and Child Health Hospital, Zhejiang, China
| | - Xiaomin Zhao
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China
| | - Ying Hua
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
| | - Xiaomei Wang
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325027, China.
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Heo JS, Kim SY, Park HW, Choi YS, Park CW, Cho GJ, Oh AY, Jang EK, Kim HS, Kim ARE, Hwang SO. 2020 Korean Guidelines for Cardiopulmonary Resuscitation. Part 8. Neonatal resuscitation. Clin Exp Emerg Med 2021; 8:S96-S115. [PMID: 34034452 PMCID: PMC8171175 DOI: 10.15441/ceem.21.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/05/2021] [Indexed: 01/02/2023] Open
Affiliation(s)
- Ju Sun Heo
- Department of Pediatrics, Korea University College of Medicine, Seoul, Korea
| | - Su Yeong Kim
- Department of Pediatrics, Chung-Ang University College of Medicine, Seoul, Korea
| | - Hye Won Park
- Department of Pediatrics, Konkuk University School of Medicine, Seoul, Korea
| | - Yong-Sung Choi
- Department of Pediatrics, Kyung Hee University School of Medicine, Seoul, Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University College of Medicine, Seoul, Korea
| | - Ah Young Oh
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Kyung Jang
- Office of Patient Safety, Yonsei University Severance Hospital, Seoul, Korea
| | - Han-Suk Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ai-Rhan Ellen Kim
- Department of Pediatrics, Ulsan University College of Medicine, Seoul, Korea
| | - Sung Oh Hwang
- Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Güner S, Saydam BK. The Impact of Umbilical Cord Clamping Time on the Infant Anemia: A Randomized Controlled Trial. IRANIAN JOURNAL OF PUBLIC HEALTH 2021; 50:990-998. [PMID: 34183957 PMCID: PMC8223556 DOI: 10.18502/ijph.v50i5.6116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Anemia during infancy causes irreversible physical, cognitive, motor, and behavioral development disorders. This study aimed to determine the effect of delaying umbilical cord clamping time on certain parameters regarding anemia during the infancy. Methods This randomized controlled trial was conducted at a university hospital in west of Turkey (Dec 2017-Dec 2018). Overall, 110 participants were evaluated for the research, 65 participants were randomized after excluding those who did not meet the inclusion criteria (intervention=32, control=33). Randomly assigned to delayed clamping (1 min after delivery) or early clamping (in 15 sec after delivery), and followed up until 4 months postpartum. 48th-hour hematocrit, bilirubin values, need for phototherapy and hematocrit, hemoglobin values, diagnosis of anemia at the postnatal fourth month were compared between two groups. The data showing normal distribution were assessed using the parametric tests. The level of statistical significance was determined as P<0.05. Results The 48th-hour hematocrit and bilirubin levels of the intervention group were significantly higher than the control (P<0.01 and P<0.05, respectively). No significant difference regarding the need for phototherapy due to postnatal hyperbilirubinemia was observed between the two groups (P>0.05). Means of the intervention group hematocrit and hemoglobin levels measured during anemia screening performed at the fourth month were found to be higher than those of the infants in the control group (P<0.05 and P<0.05, respectively). Conclusion Delaying umbilical cord clamping had a positive impact on the haematological parameters of infants. Clamping the cord at least one minute in birth can be performed to prevent the iron deficit anemia that could be seen during the first years of infants' lives.
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Affiliation(s)
- Sevil Güner
- Department of Midwifery, Mersin University, 33343, Mersin, Turkey
| | - Birsen Karaca Saydam
- Department of Midwifery, Ege University, Faculty of Health Sciences, 35100, İzmir, Turkey
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Abdelmaksoud SR, Abdelraziq HE, khashaba RA, Diab AM. Delayed Cord Clamping in Infants of Diabetic Mothers: Laboratory and Clinical Outcomes. JOURNAL OF CHILD SCIENCE 2021. [DOI: 10.1055/s-0041-1726460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AbstractThe aim of this study was to compare the effects of delayed cord clamping (DCC) and early cord clamping (ECC) on venous hematocrit (htc) and clinical outcomes in infants of diabetic mothers (IDMs). This prospective randomized study included 157 term IDMs. The umbilical cords of these infants were clamped at least 60 seconds in group I (DCC group, n = 79) and as soon as possible after birth in group II (ECC group, n = 78). The two groups were compared regarding neonatal venous htc levels, hypoglycemia rates, jaundice requiring phototherapy, respiratory distress, and admission to the neonatal intensive care unit (NICU). Hematocrit levels were significantly higher in the DCC group, both at 6 and 24 hours postnatally (p = 0.039 and 0.01), respectively. Polycythemia frequency was higher in DCC than the ECC group, but no patient in either group needed partial exchange transfusion (PET). Rates of jaundice were significantly higher in the DCC group (p = 0.028), but there was no significant difference between the two groups regarding jaundice requiring phototherapy (p = 0.681). There were no differences between the groups regarding hypoglycemia rates, need for glucose infusion, or respiratory distress. The incidence of admission to NICU was lower in the DCC group (p = 0.005). Early clamping was a significant predictor for increased risk of NICU admission. DCC increased polycythemia and jaundice rates but did not increase the need for PET or phototherapy. Also, DCC reduced the severity of respiratory distress and the subsequent need for NICU admission.
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Affiliation(s)
| | - Heba Elsayed Abdelraziq
- Department of Obstetrics and Gynecology Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Rana Atef khashaba
- Department of Clinical Pathology and Chemistry, Benha Faculty of Medicine, Benha University, Benha, Egypt
| | - Aliaa Mohamed Diab
- Department of Pediatrics, Benha Faculty of Medicine, Benha University, Benha, Egypt
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25
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Bruckner M, Katheria AC, Schmölzer GM. Delayed cord clamping in healthy term infants: More harm or good? Semin Fetal Neonatal Med 2021; 26:101221. [PMID: 33653601 DOI: 10.1016/j.siny.2021.101221] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is recommended to delay cord clamping in healthy term infants for at least 60- and 180-s in high- and limited-resource environments, as delayed cord clamping lowers the incidence of anemia and iron deficiency and improves neurodevelopment. There are improvements in hemodynamic parameters such as peripheral arterial oxygen saturation, heart rate, cardiac output, and cerebral oxygenation. Historically, delayed cord clamping caused a higher rate of hyperbilirubinemia and phototherapy, but more recent evidence suggests this may no longer be the case. In limited-resource environments delayed cord clamping may reduce anemia and iron deficiency potentially improving neurodevelopmental outcomes. The use of delayed cord clamping in newborn infants with intrauterine growth restriction or monochorionic twins is limited and further evidence is needed before it can be formally recommended.
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Affiliation(s)
- Marlies Bruckner
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Anup C Katheria
- Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States.
| | - Georg M Schmölzer
- Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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26
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Gomersall J, Berber S, Middleton P, McDonald SJ, Niermeyer S, El-Naggar W, Davis PG, Schmölzer GM, Ovelman C, Soll RF. Umbilical Cord Management at Term and Late Preterm Birth: A Meta-analysis. Pediatrics 2021; 147:peds.2020-015404. [PMID: 33632933 DOI: 10.1542/peds.2020-015404] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The International Liaison Committee on Resuscitation prioritized scientific review of umbilical cord management at term and late preterm birth. OBJECTIVE To assess effects of umbilical cord management strategies (clamping timing and cord milking) in infants ≥34 weeks' gestational age. DATA SOURCES Cochrane Central Register of Controlled Trials, Medline, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and trial registries searched July 2019. STUDY SELECTION Two authors independently assessed eligibility of randomized controlled trials. DATA EXTRACTION Two authors independently extracted data and assessed evidence certainty (Grading of Recommendations Assessment, Development and Evaluations). RESULTS We identified 46 studies (9159 women and their infants) investigating 7 comparisons. Compared with early cord clamping (ECC) <30 seconds, delayed cord clamping (DCC) ≥30 seconds (33 studies), intact-cord milking (1 study), and cut-cord milking (2 studies) probably improve hematologic measures but may not affect survival without neurodisability, anemia in early infancy, or maternal postpartum hemorrhage. No differences in major neonatal morbidities are seen in studies comparing methods of optimizing placental transfusion (DCC versus cut-cord milking [3 studies], longer delays in clamping [7 studies], or physiologic parameters [3 studies]). Strategies that promote increased placental transfusion may be associated with greater phototherapy use. Evidence for all outcomes was low or very low certainty. LIMITATIONS Incompleteness and low certainty of findings limit applicability. CONCLUSIONS Compared with ECC, DCC or cord milking increases hemoglobin and hematocrit immediately after birth in infants ≥34 weeks' gestational age. The uncertain effects of DCC and cord milking compared with ECC on major morbidities limit usefulness of available evidence for policy and practice.
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Affiliation(s)
- Judith Gomersall
- Women and Children's Hospital, South Australian Health and Medical Research Institute and The University of Adelaide, Adelaide, South Australia, Australia;
| | - Slavica Berber
- Cochrane Breast Cancer Group, Systematic Reviews and Health Technology Assessments National Health and Medical Research Council Clinical Trials Centre, The University of Sydney, Sydney, New South Wales, Australia
| | - Philippa Middleton
- Women and Children's Hospital, South Australian Health and Medical Research Institute and The University of Adelaide, Adelaide, South Australia, Australia
| | - Susan J McDonald
- Midwifery Professorial Unit, La Trobe University and Mercy Hospital for Women, Melbourne, Victoria, Australia
| | - Susan Niermeyer
- Department of Pediatrics, Section of Neonatology, University of Colorado School of Medicine
| | - Walid El-Naggar
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Peter G Davis
- Newborn Research Centre, The Royal Women's Hospital and The University of Melbourne, Melbourne, Victoria, Australia
| | - Georg M Schmölzer
- Division of Neonatology, Department of Pediatrics, Medical University Graz, Graz, Austria; and
| | - Colleen Ovelman
- Department of Pediatrics, The Robert Larner College of Medicine, The University of Vermont, Burlington, Vermont
| | - Roger F Soll
- Department of Pediatrics, The Robert Larner College of Medicine, The University of Vermont, Burlington, Vermont
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Zanardo V, Guerrini P, Severino L, Simbi A, Parotto M, Straface G. A Randomized Controlled Trial of Intact Cord Milking versus Immediate Cord Clamping in Term Infants Born by Elective Cesarean Section. Am J Perinatol 2021; 38:392-397. [PMID: 31600796 DOI: 10.1055/s-0039-1697673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We evaluated whether intact umbilical cord milking (UCM) is more effective than immediate cord clamping (ICC) in enhancing placental transfusion after elective cesarean delivery. STUDY DESIGN In a randomized trial, volume of placental transfusion was assessed by Δ hematocrit (Hct) between neonatal cord blood and capillary heel blood at 48 hours of age, corrected for the change in body weight. RESULTS There were no significant differences in cord blood mean Hct values at birth (UCM, 44.5 ± 4.8 vs. ICC, 44.9 ± 4.2%, p = 0.74). Conversely, at 48 hours of age, the UCM group had significantly higher capillary heel Hct values (UCM, 53.7 ± 5.9 vs. ICC, 49.8 ± 4.6%, p < 0.001), supporting a higher placental transfusion volume (Δ Hct, UCM 9.2 ± 5.2 vs. ICC 4.8 ± 4.7, p < 0.001), despite comparable neonatal body weight decrease (UCM, -7.3 vs. ICC, -6.8%, p = 0.77). CONCLUSION Higher Δ Hct between cord blood at birth and capillary heel blood at 48 hours of age, corrected for the change in body weight, suggests that intact UCM is an efficacious and safe procedure to enhance placental transfusion among neonates born via elective cesarean delivery. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, www.clinicaltrials.gov, NCT03668782.
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Affiliation(s)
- Vincenzo Zanardo
- Division of Perinatal Medicine, Policlinico AbanoTerme, Abano Terme, Italy
| | - Pietro Guerrini
- Division of Perinatal Medicine, Policlinico AbanoTerme, Abano Terme, Italy
| | - Lorenzo Severino
- Division of Perinatal Medicine, Policlinico AbanoTerme, Abano Terme, Italy
| | - Alphonse Simbi
- Division of Perinatal Medicine, Policlinico AbanoTerme, Abano Terme, Italy
| | - Matteo Parotto
- Department of Anesthesiology, Toronto University, Toronto, Canada
| | - Gianluca Straface
- Division of Perinatal Medicine, Policlinico AbanoTerme, Abano Terme, Italy
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Korkut S, Oğuz Y, Bozkaya D, Türkmen GG, Kara Ö, Uygur D, Oğuz ŞS. Evaluation of the Effects of Delayed Cord Clamping in Infants of Diabetic Mothers. Am J Perinatol 2021; 38:242-247. [PMID: 31563135 DOI: 10.1055/s-0039-1695799] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aimed to investigate the effect of delayed cord clamping (DCC) in infants of diabetic mothers. STUDY DESIGN Women who had diabetes throughout their pregnancy and gave birth at 37 weeks of gestation or later were included in the study along with their babies. Early cord clamping was performed as soon as possible after birth, while DCC was performed by clamping 60 second after birth. The two groups were compared in terms of venous hematocrit (htc) levels and rates of hypoglycemia, jaundice requiring phototherapy, and respiratory distress. RESULTS Venous htc levels at postnatal 6 and 24 hours were significantly higher in the DCC group (p = 0.0001). Polycythemia rates were higher in the DCC group at both 6 and 24 hours, but partial exchange transfusion (PET) was not needed in either group. There were no differences between the groups with regard to the rates of hypoglycemia or jaundice requiring phototherapy. Rate of admission to the neonatal intensive care unit (NICU) was lower in the DCC group. CONCLUSION Although DCC increased the rate of polycythemia, it did not result in PET requirement. Moreover, DCC reduced the severity of respiratory distress and the rate of admission to NICU due to respiratory distress.
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Affiliation(s)
- Sabriye Korkut
- Department of Neonatology, University of Health Sciences, Faculty of Medicine, Zekai Tahir Burak Women's Helath Training and Research Hospital, Ankara 06230, Turkey
| | - Yüksel Oğuz
- Department of Perinatology, University of Health Sciences, Faculty of Medicine, Zekai Tahir Burak Women's Helath Training and Research Hospital, Ankara, Turkey
| | - Davut Bozkaya
- Department of Neonatology, University of Health Sciences, Faculty of Medicine, Zekai Tahir Burak Women's Helath Training and Research Hospital, Ankara 06230, Turkey
| | - Gülenay Gençosmanoğlu Türkmen
- Department of Perinatology, University of Health Sciences, Faculty of Medicine, Zekai Tahir Burak Women's Helath Training and Research Hospital, Ankara, Turkey
| | - Özgür Kara
- Department of Perinatology, University of Health Sciences, Faculty of Medicine, Zekai Tahir Burak Women's Helath Training and Research Hospital, Ankara, Turkey
| | - Dilek Uygur
- Department of Perinatology, University of Health Sciences, Faculty of Medicine, Zekai Tahir Burak Women's Helath Training and Research Hospital, Ankara, Turkey
| | - Şerife Suna Oğuz
- Department of Neonatology, University of Health Sciences, Faculty of Medicine, Zekai Tahir Burak Women's Helath Training and Research Hospital, Ankara 06230, Turkey
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Shinohara E, Kataoka Y, Yaju Y. Effects of timing of umbilical cord clamping on preventing early infancy anemia in low-risk Japanese term infants with planned breastfeeding: a randomized controlled trial. Matern Health Neonatol Perinatol 2021; 7:5. [PMID: 33468261 PMCID: PMC7814648 DOI: 10.1186/s40748-021-00125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Japanese infants have relatively higher risk of anemia and neonatal jaundice. This study aimed to assess the effects of delayed cord clamping (DCC) on the incidence of anemia during early infancy in low-risk Japanese term infants with planned exclusive breastfeeding for 4 months. This study also aimed to explore the effects of DCC on neonatal jaundice. METHODS We conducted an open-label, parallel-arm, multicenter randomized controlled trial of DCC (clamping the cord after more than a minute or pulsation stops) vs. early cord clamping (ECC; clamping the cord within 15 s) at one birth center and two clinics in Japan. Low-risk pregnant women planning to have a vaginal birth and to exclusively breastfeed and term singleton infants delivered in cephalic presentation were included in this study. The primary outcome was spectrophotometric estimation of hemoglobin at 4 months. Secondary outcomes were anemia incidence at 4 months, four outcomes related to neonatal jaundice, hematocrit levels, and related outcomes. RESULTS Overall, 150 pregnant women were recruited. Participants (N = 138) were randomly allocated to two groups (DCC n = 68, ECC n = 70). There were no significant differences between the two groups in spectrophotometric estimation of hemoglobin at 4 months: mean difference = 0.1 g/dL, 95% confidence interval - 0.14, 0.35, DCC 12.4 g/dL, ECC 12.3 g/dL. Only the hematocrit levels on days 3 to 5 were significantly higher in the DCC group than in the ECC group: DCC 57.0%, ECC 52.6%, mean difference = 4.4, 95% confidence interval 2.61, 6.20. There were no significant differences in other secondary outcomes, including outcomes related to neonatal jaundice. CONCLUSION Among low-risk Japanese term infants with planned exclusive breastfeeding, DCC showed no significant effects on spectrophotometric hemoglobin levels at 4 months compared with ECC. We observed significantly higher hematocrit levels on days 3 to 5 in infants who underwent DCC, while these levels were within the normal range. Jaundice outcomes remained similar to those of infants who underwent ECC. Although a larger sample size is required to assess the effects of cord clamping on neonatal jaundice, DCC may prevent anemia in newborn infants. TRIAL REGISTRATION UMIN-CTR; UMIN000022573, 06/01/2016 - retrospectively registered, https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000023056.
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Affiliation(s)
- Eriko Shinohara
- Department of Nursing, School of Medicine, Yokohama City University, 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa, 236-0004, Japan.
| | - Yaeko Kataoka
- Division of Women's Health and Midwifery, Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
| | - Yukari Yaju
- Division of Epidemiology and Statistics, Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan
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SATAR M, BAHAR N, ŞİMŞEK H, YAPICIOĞLU H, ÖZLÜ F, BÜYÜKKURT S. Geciktirilmiş kord klemplemenin term ve geç preterm bebeklerin kısa dönem klinik ve laboratuvar bulgularına etkisi. CUKUROVA MEDICAL JOURNAL 2020. [DOI: 10.17826/cumj.736750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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31
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Marzec L, Zettler E, Cua CL, Rivera BK, Pasquali S, Katheria A, Backes CH. Timing of umbilical cord clamping among infants with congenital heart disease. PROGRESS IN PEDIATRIC CARDIOLOGY 2020; 59:101318. [PMID: 34113067 PMCID: PMC8186731 DOI: 10.1016/j.ppedcard.2020.101318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The optimal timing of clamping and cutting the umbilical cord at birth among infants with congenital heart disease (CHD) remains a subject of controversy and debate. The benefits of delayed umbilical cord clamping (DCC) among term infants without CHD are well described, but the evidence base for DCC among infants with CHD has not been characterized adequately. The goals of the present review are to: 1) compare outcomes of DCC versus early cord clamping (ECC) in term (≥37 weeks of gestation) infants; 2) discuss potential risk/benefit profiles in applying DCC among term infants with CHD; 3) use rigorous systematic review methodology to assess the quality and quantity of published reports on cord clamping practices among term infants with CHD; 4) identify needs and opportunities for future research and interdisciplinary collaboration. Our systematic review shows that previous trials have largely excluded infants with CHD. Therefore, the supposition that DCC is advantageous because it is associated with improved neurologic and hematologic outcome is untested in the CHD population. Given that CHD is markedly heterogeneous, to minimize unnecessary and potentially harmful cord clamping practices, identification of subgroups (single-ventricle, cyanotic lesions) most likely to benefit from optimal cord clamping practices is necessary to optimize risk/benefit profiles. The available evidence base suggests that contemporary, pragmatic, randomized controlled trials comparing DCC with ECC among infants with CHD are needed.
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Affiliation(s)
- Laura Marzec
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Eli Zettler
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Clifford L Cua
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH
| | - Brian K Rivera
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH
| | | | - Anup Katheria
- Sharp Mary Birch Hospital for Women and Newborns, San Diego, CA
| | - Carl H Backes
- Center for Perinatal Research, The Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH
- Department of Pediatrics, The Ohio State University Wexner Medical Center, Columbus, OH
- The Heart Center at Nationwide Children's Hospital, Columbus, OH
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32
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Hemmati F, Sharma D, Namavar Jahromi B, Salarian L, Farahbakhsh N. Delayed cord clamping for prevention of intraventricular hemorrhage in preterm neonates: a randomized control trial. J Matern Fetal Neonatal Med 2020; 35:3633-3639. [PMID: 33092420 DOI: 10.1080/14767058.2020.1836148] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Intraventricular hemorrhage (IVH) is a common condition in preterm neonates and is responsible for substantial adverse neurodevelopmental outcome in preterm neonates. Prevention of IVH is an important intervention for better neurological outcome in these preterm neonates. AIMS AND OBJECTIVE This study aimed to determine whether delayed cord clamping (DCC) was superior to immediate cord clamping (ICC) for the prevention of IVH in preterm neonates. PATIENTS AND METHODS In this two centered prospective double-blind randomized controlled trial, eligible neonates with gestational age from 26 to 34 weeks were randomized to receive either ICC (cord clamped in 10-15 s) or DCC (cord clamped in 30-45 s) groups. The grading and severity of IVH were evaluated by cranial ultrasound scan done on the 3-4th and 7-10th days after birth. RESULTS Among the 148 enrolled neonates, 79 were in the ICC group and 69 were in the DCC group. There was no difference in maternal and neonatal baseline characteristics except the neonates in the DCC group weighed more (ICC 1528.77 ± 365.5 g vs. DCC 1658.11 ± 419.52 g; p = .047) at birth. There was no significant difference in the incidence of any grade of IVH in both groups (ICC 12.8% vs. DCC 14.5%; p = .745). There was a significantly higher incidence of grade I IVH (ICC 2.5% vs. DCC 13%; p = .024) in the DCC group. The incidence of grade II IVH (ICC 5.1% vs. DCC 0%; p = .123); grade III IVH (ICC 3.8% vs. DCC 1.4%; p = .623); and grade IV IVH (ICC 1.3% vs. DCC 0%; p>.999) were comparable between the two groups. The incidence of a significant IVH (grades II, III, and IV) was significantly less in the DCC group (ICC 10.1% vs. DCC 1.4%, p = .036). The mean initial hemoglobin levels were significantly higher in neonates enrolled in DCC (15.41 ± 2.1 vs. 16.46 ± 2.45 g/dL; p = .007). There was a significant reduction in the number of days of hospital stay (ICC 18.78 ± 15.42 vs. DCC 13.21 ± 16.16; p = .002). There was no difference in initial hematocrit, platelet count, maximum bilirubin level, and Apgar score (p>.05). CONCLUSIONS Although there was no reduction in any grade of IVH, the incidence of significant IVH (grades II, III, and IV) was significantly decreased with the use of DCC in preterm neonates. Delayed cord clamping also resulted in a significant increase in birth weight, higher hemoglobin levels, and shorter hospital stays without any increase in the risks of hyper-bilirubinemia, low Apgar score, and neonatal mortality. TRIAL REGISTRY IRCT2014031116936N1, https://www.irct.ir/trial/15707.
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Affiliation(s)
- Fariba Hemmati
- Department of Pediatrics, School of Medicine, Neonatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Deepak Sharma
- Department of Neonatology, National Institute of Medical Science, Jaipur, India
| | - Bahia Namavar Jahromi
- Department of OB-GYN, School of Medicine, Maternal-Fetal Medicine Research Center, Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Salarian
- Department of Pediatrics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazanin Farahbakhsh
- Department of Pulmonology, Pediatric Department, Mofid Children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Aziz K, Lee HC, Escobedo MB, Hoover AV, Kamath-Rayne BD, Kapadia VS, Magid DJ, Niermeyer S, Schmölzer GM, Szyld E, Weiner GM, Wyckoff MH, Yamada NK, Zaichkin J. Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S524-S550. [DOI: 10.1161/cir.0000000000000902] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Shinohara E, Kataoka Y. Prevalence and risk factors for hyperbilirubinemia among newborns from a low-risk birth setting using delayed cord clamping in Japan. Jpn J Nurs Sci 2020; 18:e12372. [PMID: 32803859 DOI: 10.1111/jjns.12372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 06/14/2020] [Accepted: 06/29/2020] [Indexed: 12/27/2022]
Abstract
AIM Neonatal jaundice is a common problem among infants. Among the several risk factors are East Asian race and delayed cord clamping. Birth centers manage low-risk term deliveries using physiological management, which may include delayed cord clamping. This study aimed to investigate the occurrence of hyperbilirubinemia, a pathological process of jaundice, and its risk factors among neonates born at a Japanese birth center. METHODS This was a retrospective cohort study. Data were collected from March 2006 to October 2014 from healthy mothers and neonates at a birth center in a metropolitan area of Japan. Demographic data and background factors of hyperbilirubinemia, including blood and transcutaneous values of jaundice, were collected and statistically analyzed. RESULTS Of the 1,211 neonates analyzed, 4.7% exceeded the standard transcutaneous bilirubin value, and 1.8% needed phototherapy. Multiple logistic regression with adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) was used to identify the risk factors of hyperbilirubinemia, which were found to be cephalohematoma (OR = 30.18, 95% CI 5.63-161.69), delay of meconium elimination (OR = 2.66, 95% CI 1.28-5.51), previous history of phototherapy of siblings (OR = 10.28, 95% CI 3.53-29.92), and primiparity (OR = 4.55, 95% CI 2.59-8.02). CONCLUSIONS In low-risk Japanese neonates delivered at a birth center expected to practice delayed cord clamping, the rate of neonates requiring phototherapy was not high compared to previous studies, and the identified risk factors of hyperbilirubinemia were related to bilirubin metabolism.
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Affiliation(s)
- Eriko Shinohara
- Graduate School of Nursing Science, St. Luke's International University, Tokyo, Japan
| | - Yaeko Kataoka
- Division of Women's Health and Midwifery, St. Luke's International University, Tokyo, Japan
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Zanardo V, Tortora D, Parotto M, Severino L, Simbi A, Guerrini P, Straface G. Determinants and effects of fluid status changes in caesarean delivered neonates. Acta Paediatr 2020; 109:1545-1550. [PMID: 31887232 DOI: 10.1111/apa.15152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/05/2019] [Accepted: 12/27/2019] [Indexed: 12/01/2022]
Abstract
AIM Evidence suggests that caesarean section is associated with a reduced placental transfusion and poor iron-related haematological indices, both in cord and peripheral blood, compared with vaginal delivery. We assessed determinants and effects of fluid status changes on placental transfusion in neonates delivered by elective (ElCD) and emergency (EmCD) caesarean section. METHODS Placental transfusion was estimated by ∆ haematocrit (Hct) increase from birth to 48 hours of life, accounting for contemporaneous ∆ body weight decrease, in 143 women/infant pairs, 62 who underwent ElCD and 81 EmCD, respectively. RESULTS Cord blood Hct levels at birth of ElCS neonates were significantly lower than those of EmCD neonates (44.58 + 4.87vs 49.93 + 4.29, P = .01). At 48 hours of life, capillary heel Hct levels of ElCD and of EmCD neonates were comparable. ElCD had a higher ∆ body weight decrease (ElCD -7.25 ± 1.74% vs EmCD -6.31 ± 2.34% [P: .011]) and ∆ Hct increase ([ElCD + 5.93 ± 4.92 vs EmCD + 3.59 ± 5.29, [P: .011]). In a linear regression model analysis, gestational age in ElCD neonates had a significant effect on the differences in arterial cord blood Hct, body weight at birth and body weight decrease at 48 hours after birth. CONCLUSION Early-term surgical delivery is a determinant of transient dilutional anaemia in ElCD neonates, lacking neuroendocrine response of labour and delivery.
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Affiliation(s)
- Vincenzo Zanardo
- Division of Perinatal Medicine Policlinico Abano Terme Abano Terme Italy
| | - Domenico Tortora
- Neuroradiology Unit IRCCS Istituto Giannina Gaslini Genova Italy
| | - Matteo Parotto
- Department of Anaesthesia University of Toronto Toronto ON Canada
| | - Lorenzo Severino
- Division of Perinatal Medicine Policlinico Abano Terme Abano Terme Italy
| | - Alphonse Simbi
- Division of Perinatal Medicine Policlinico Abano Terme Abano Terme Italy
| | - Pietro Guerrini
- Division of Perinatal Medicine Policlinico Abano Terme Abano Terme Italy
| | - Gianluca Straface
- Division of Perinatal Medicine Policlinico Abano Terme Abano Terme Italy
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Songthamwat M, Witsawapaisan P, Tanthawat S, Songthamwat S. Effect of Delayed Cord Clamping at 30 Seconds and 1 Minute on Neonatal Hematocrit in Term Cesarean Delivery: A Randomized Trial. Int J Womens Health 2020; 12:481-486. [PMID: 32607000 PMCID: PMC7320901 DOI: 10.2147/ijwh.s248709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/09/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the effect of delayed cord clamping at 30 seconds and 1 minute on the incidence of neonatal hematocrit, anemia, maternal and neonatal complications in term cesarean delivered neonates. Methods An opened labelled, randomized controlled trial was undertaken. The 160 healthy term cesarean-born neonates were randomly allocated to either 30 seconds or 1-minute groups of delayed cord clamping (DCC) (groups 1 and 2). Neonatal venous hematocrit (Hct) and microbilirubin (Mb) were measured at 48–72 hours after birth. Results One hundred and fifty-nine neonates completed this study. Mean neonatal hematocrit ± standard deviation at 48–72 hours was 49.9 ± 6.0% in group 1 and 51.2 ± 5.9% in group 2 without a statistical difference. Neonatal anemia (Hct less than 45%) occurred in 14/79 neonates (17.7%) in group 1 and in 8/80 cases (10.0%) in group 2 without a significant difference between groups. The incidence of neonatal jaundice and polycythemia (hematocrit more than 65%) was similar between groups. There were no significant differences; in the estimated blood loss during the operation, the incidence of postpartum hemorrhage and other maternal and neonatal complications. Conclusion Neonatal hematocrit was not significantly different following DCC at 30 seconds and at 1 minute, but the incidence of neonatal anemia decreased with the longer timing of DCC. The estimated blood loss and other complications were not different between the two groups. Therefore, one minute-DCC should be considered for neonatal anemic prevention when compared with 30 seconds-DCC.
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Affiliation(s)
- Metha Songthamwat
- Department of Obstetrics and Gynecology, Udonthani Hospital, Udonthani, Thailand
| | | | - Sopida Tanthawat
- Department of Pediatrics, Udonthani Hospital, Udonthani, Thailand
| | - Srisuda Songthamwat
- Department of Obstetrics and Gynecology, Udonthani Hospital, Udonthani, Thailand
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Blumovich A, Mangel L, Yochpaz S, Mandel D, Marom R. Risk factors for readmission for phototherapy due to jaundice in healthy newborns: a retrospective, observational study. BMC Pediatr 2020; 20:248. [PMID: 32456623 PMCID: PMC7249410 DOI: 10.1186/s12887-020-02157-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The guidelines of the American Academy of Pediatrics (AAP) for monitoring neonatal jaundice recommend universal postnatal screening for hyperbilirubinemia within 48 h from discharge. We observed that neonate with low-risk jaundice were more likely to be readmitted to hospital for phototherapy compared to neonate with high-risk jaundice. The aim of this study was to identify additional factors that increase the risk for jaundice-related readmission. METHODS This observational case-control study was performed on 100 consecutive neonates with jaundice who were readmitted to hospital for phototherapy treatment and were compared to 100 neonates with jaundice during hospitalization who were not readmitted after discharge. The data retrieved from the medical records of all participants included maternal characteristics, delivery type and noteworthy events, gestational age at delivery, birth weight and weight loss, neonate physical findings, Apgar scores, laboratory findings, length of hospital stay, and administration of phototherapy during hospitalization. The length of time since discharge and readmission for jaundice was also recorded. RESULTS The risk of readmission decreased by 48% [odds ratio (OR) =0.52; 95% confidence interval (CI) 0.341-0.801] with every day added to the original hospitalization stay, and by 71% (OR = 0.29; 95% CI 0.091-0.891) if phototherapy had been administered during postnatal hospitalization. In contrast, the risk increased by 28% (OR = 1.28; 95% CI 1.164-1.398) with every elevation by 1% in hematocrit, and by 2.78 time (95% CI 1.213-6.345; p = 0.0156) when the delta in infant weight was > 5% (the difference between birth weight and weight at discharge during the postnatal hospitalization). CONCLUSIONS The risk factors for readmission, such as substantial weight loss (> 5% difference between birth and discharge) and elevated hematocrit should be taken into account in the decision to discharge neonate with low-risk jaundice. The AAP guidelines for decreasing readmission rates of neonatal jaundice by postnatal screening for hyperbilirubinemia alone may be more appropriate for neonate with high-risk jaundice.
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Affiliation(s)
- Amit Blumovich
- Department of Neonatology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St, 6423906, Tel Aviv, Israel
| | - Laurence Mangel
- Department of Neonatology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St, 6423906, Tel Aviv, Israel
| | - Sivan Yochpaz
- Department of Neonatology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St, 6423906, Tel Aviv, Israel
| | - Dror Mandel
- Department of Neonatology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St, 6423906, Tel Aviv, Israel
| | - Ronella Marom
- Department of Neonatology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, 6 Weizmann St, 6423906, Tel Aviv, Israel.
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Panburana P, Odthon T, Pongmee P, Hansahiranwadee W. The Effect of Umbilical Cord Milking Compared with Delayed Cord Clamping in Term Neonates: A Randomized Controlled Trial. Int J Womens Health 2020; 12:301-306. [PMID: 32368158 PMCID: PMC7173835 DOI: 10.2147/ijwh.s233487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 03/18/2020] [Indexed: 11/23/2022] Open
Abstract
Objective To study the effect of intact umbilical cord milking (I-UCM) procedure in comparison with the procedure of delayed cord clamping (DCC) in term neonates. Study Design A randomized controlled trial. Setting Department of Obstetrics and Gynecology and Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University. Materials and Methods The study was performed from June 2017 to March 2018. Singleton term pregnant women (37-42 weeks' gestation) were recruited. Neonates were randomized into DCC and I-UCM groups. Umbilical cord was 3 times milked toward the neonate in 25 cm length from umbilical stump which was still attached to the placenta before cutting the cord in I-UCM group. Delay in cord clamping for 60 seconds was performed before the cord cutting in DCC group. Neonatal and maternal outcomes were recorded. Results Of 168 neonates included in this trial, 84 cases were randomized into each group. The baseline characteristics of both groups were comparable. No statistical difference was found in terms of the mean of hemoglobin levels in the DCC and I-UCM groups which were 16.9 (±1.6) g/dl and 17.0 (±1.9) g/dl, respectively (P-value 0.75). There was no difference in terms of adverse neonatal and maternal outcomes in both groups. Conclusion Both I-UCM and DCC revealed a comparable effect on hematologic status without deleterious effects on neonatal and maternal outcomes at the age of 48-72 hours in term neonates.
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Affiliation(s)
- Panyu Panburana
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Theethuch Odthon
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pharuhad Pongmee
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wirada Hansahiranwadee
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Timing of umbilical cord clamping and neonatal jaundice in singleton term pregnancy. Early Hum Dev 2020; 142:104948. [PMID: 31927308 DOI: 10.1016/j.earlhumdev.2019.104948] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 12/17/2019] [Accepted: 12/30/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Delayed cord clamping was not adopted widely in China because of the potential effect of neonatal hyperbilirubinemia, jaundice and polycythemia, and the optimal cord clamping time remained controversial. AIM To assess the effect of delayed cord clamping versus early cord clamping on neonatal jaundice for term infants. STUDY DESIGN This retrospective study included 1981 mother-infant pairs, who were assigned to early cord clamping groups (n = 1005) and delayed cord clamping group (n = 949). The delayed cord clamping included three subgroups (30-60 s, 61-90 s, 91-120 s). The main outcomes were transcutaneous bilirubin levels at 0 to 4 days of age, the rate of jaundice requiring phototherapy, the neonatal hematological status at 1 to 3 days after birth. RESULTS Compared with the early cord clamping group, the neonatal transcutaneous bilirubin level did not differ and the neonatal hematological status (hemoglobin and hematocrit levels) were improved in combined and three subgroups of delayed cord clamping group. Increasing the duration of cord clamping from 90 s to 120 s did not result in further increases in hemoglobin and hematocrit levels but led to a trend towards a higher risk of neonatal jaundice requiring phototherapy and neonatal polycythemia. CONCLUSIONS Delayed cord clamping for <90 s in healthy term infants may not only improve the early hematological status of newborns but also avoid excessive neonatal jaundice requiring phototherapy.
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Purisch SE, Ananth CV, Arditi B, Mauney L, Ajemian B, Heiderich A, Leone T, Gyamfi-Bannerman C. Effect of Delayed vs Immediate Umbilical Cord Clamping on Maternal Blood Loss in Term Cesarean Delivery: A Randomized Clinical Trial. JAMA 2019; 322:1869-1876. [PMID: 31742629 PMCID: PMC6865311 DOI: 10.1001/jama.2019.15995] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
IMPORTANCE The American College of Obstetricians and Gynecologists recommends a delay in umbilical cord clamping in term neonates for at least 30 to 60 seconds after birth. Most literature supporting this practice is from low-risk vaginal deliveries. There are no published data specific to cesarean delivery. OBJECTIVE To compare maternal blood loss with immediate cord clamping vs delayed cord clamping in scheduled cesarean deliveries at term (≥37 weeks). DESIGN, SETTING, AND PARTICIPANTS Randomized clinical trial performed at 2 hospitals within a tertiary academic medical center in New York City from October 2017 to February 2018 (follow-up completed March 15, 2018). A total of 113 women undergoing scheduled cesarean delivery of term singleton gestations were included. INTERVENTIONS In the immediate cord clamping group (n = 56), cord clamping was within 15 seconds after birth. In the delayed cord clamping group (n = 57), cord clamping was at 60 seconds after birth. MAIN OUTCOMES AND MEASURES The primary outcome was change in maternal hemoglobin level from preoperative to postoperative day 1, which was used as a proxy for maternal blood loss. Secondary outcomes included neonatal hemoglobin level at 24 to 72 hours of life. RESULTS All of the 113 women who were randomized (mean [SD] age, 32.6 [5.2] years) completed the trial. The mean preoperative hemoglobin level was 12.0 g/dL in the delayed and 11.6 g/dL in the immediate cord clamping group. The mean postoperative day 1 hemoglobin level was 10.1 g/dL in the delayed group and 9.8 g/dL in the immediate group. There was no significant difference in the primary outcome, with a mean hemoglobin change of -1.90 g/dL (95% CI, -2.14 to -1.66) and -1.78 g/dL (95% CI, -2.03 to -1.54) in the delayed and immediate cord clamping groups, respectively (mean difference, 0.12 g/dL [95% CI, -0.22 to 0.46]; P = .49). Of 19 prespecified secondary outcomes analyzed, 15 showed no significant difference. The mean neonatal hemoglobin level, available for 90 neonates (79.6%), was significantly higher with delayed (18.1 g/dL [95% CI, 17.4 to 18.8]) compared with immediate (16.4 g/dL [95% CI, 15.9 to 17.0]) cord clamping (mean difference, 1.67 g/dL [95% CI, 0.75 to 2.59]; P < .001). There was 1 unplanned hysterectomy in each group. CONCLUSIONS AND RELEVANCE Among women undergoing scheduled cesarean delivery of term singleton pregnancies, delayed umbilical cord clamping, compared with immediate cord clamping, resulted in no significant difference in the change in maternal hemoglobin level at postoperative day 1. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03150641.
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Affiliation(s)
| | - Cande V. Ananth
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, New Jersey
- Environmental and Occupational Health Sciences Institute, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
| | - Brittany Arditi
- Columbia University Irving Medical Center, New York, New York
- Icahn School of Medicine at Mount Sinai, New York, New York
| | - Logan Mauney
- Columbia University Irving Medical Center, New York, New York
- Brigham & Women’s Hospital, Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston
| | - Barouyr Ajemian
- Columbia University Irving Medical Center, New York, New York
| | - Amy Heiderich
- Columbia University Irving Medical Center, New York, New York
| | - Tina Leone
- Columbia University Irving Medical Center, New York, New York
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Liston R, Sawchuck D, Young D. No. 197b-Fetal Health Surveillance: Intrapartum Consensus Guideline. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:e298-e322. [PMID: 29680084 DOI: 10.1016/j.jogc.2018.02.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This guideline provides new recommendations pertaining to the application and documentation of fetal surveillance in the intrapartum period that will decrease the incidence of birth asphyxia while maintaining the lowest possible rate of obstetrical intervention. Pregnancies with and without risk factors for adverse perinatal outcomes are considered. This guideline presents an alternative classification system for antenatal fetal non-stress testing and intrapartum electronic fetal surveillance to what has been used previously. This guideline is intended for use by all health professionals who provide intrapartum care in Canada. OPTIONS Consideration has been given to all methods of fetal surveillance currently available in Canada. OUTCOMES Short- and long-term outcomes that may indicate the presence of birth asphyxia were considered. The associated rates of operative and other labour interventions were also considered. EVIDENCE A comprehensive review of randomized controlled trials published between January 1996 and March 2007 was undertaken, and MEDLINE and the Cochrane Database were used to search the literature for all new studies on fetal surveillance antepartum. The level of evidence has been determined using the criteria and classifications of the Canadian Task Force on Preventive Health Care (Table 1). SPONSOR This consensus guideline was jointly developed by the Society of Obstetricians and Gynaecologists of Canada and the British Columbia Perinatal Health Program (formerly the British Columbia Reproductive Care Program or BCRCP) and was partly supported by an unrestricted educational grant from the British Columbia Perinatal Health Program. RECOMMENDATION 1: LABOUR SUPPORT DURING ACTIVE LABOUR: RECOMMENDATION 2: PROFESSIONAL ONE-TO ONE CARE AND INTRAPARTUM FETAL SURVEILLANCE: RECOMMENDATION 3: INTERMITTENT AUSCULTATION IN LABOUR: RECOMMENDATION 4: ADMISSION FETAL HEART TEST: RECOMMENDATION 5: INTRAPARTUM FETAL SURVEILLANCE FOR WOMEN WITH RISK FACTORS FOR ADVERSE PERINATAL OUTCOME: When a normal tracing is identified, it may be appropriate to interrupt the electronic fetal monitoring tracing for up to 30 minutes to facilitate periods of ambulation, bathing, or position change, providing that (1) the maternal-fetal condition is stable and (2) if oxytocin is being administered, the infusion rate is not increased (III-B). RECOMMENDATION 6: DIGITAL FETAL SCALP STIMULATION: RECOMMENDATION 7: FETAL SCALP BLOOD SAMPLING: RECOMMENDATION 8: UMBILICAL CORD BLOOD GASES: RECOMMENDATION 9: FETAL PULSE OXIMETRY: RECOMMENDATION 10: ST WAVEFORM ANALYSIS: RECOMMENDATION 11: INTRAPARTUM FETAL SCALP LACTATE TESTING.
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Liston R, Sawchuck D, Young D. N° 197b-Surveillance du bien-être fœtal : Directive consensus d'intrapartum. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 40:e323-e352. [PMID: 29680085 DOI: 10.1016/j.jogc.2018.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bhargava S, Chen X, Howell H, Desai P. Optimal Timing and Methodology of Umbilical Cord Clamping in Preterm Infants: a Review. CURRENT PEDIATRICS REPORTS 2019. [DOI: 10.1007/s40124-019-00197-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Early versus delayed umbilical cord clamping on maternal and neonatal outcomes. Arch Gynecol Obstet 2019; 300:531-543. [PMID: 31203386 PMCID: PMC6694086 DOI: 10.1007/s00404-019-05215-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 06/07/2019] [Indexed: 12/12/2022]
Abstract
Purpose Policies for timing of cord clamping varied from early cord clamping (ECC) in the first 30 s after birth, to delayed cord clamping (DCC) in more than 30 s after birth or when cord pulsation has ceased. DCC, an inexpensive method allowed physiological placental transfusion. The aim of this article is to review the benefits and the potential harms of early versus delayed cord clamping. Methods Narrative overview, synthesizing the findings of the literature retrieved from searches of computerized databases. Results Delayed cord clamping in term and preterm infants had shown higher hemoglobin levels and iron storage, the improved infants’ and children’s neurodevelopment, the lesser anemia, the higher blood pressure and the fewer transfusions, as well as the lower rates of intraventricular hemorrhage (IVH), chronic lung disease, necrotizing enterocolitis, and late-onset sepsis. DCC was seldom associated with lower Apgar scores, neonatal hypothermia of admission, respiratory distress, and severe jaundice. In addition, DCC was not associated with increased risk of postpartum hemorrhage and maternal blood transfusion whether in cesarean section or vaginal delivery. DCC appeared to have no effect on cord blood gas analysis. However, DCC for more than 60 s reduced drastically the chances of obtaining clinically useful cord blood units (CBUs). Conclusion Delayed cord clamping in term and preterm infants was a simple, safe, and effective delivery procedure, which should be recommended, but the optimal cord clamping time remained controversial.
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Fernandez A, Chasovskyi K. The Use of Umbilical Cord Blood for Autologous Transfusion in Neonatal Open Heart Surgery. J Cardiothorac Vasc Anesth 2019; 34:483-488. [PMID: 31151859 DOI: 10.1053/j.jvca.2019.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 12/29/2022]
Abstract
In the last few decades, the use of umbilical cord blood (UCB) has received increasing attention, not only as a source of stem cells, but also as a transfusion product for the treatment of anemia in the neonatal and even the adult population. This review focuses on data reports and collection efforts related to the autologous transfusion of UCB in full-term neonates with prenatally diagnosed critical congenital heart defects. This review summarizes different aspects of UCB transfusion, including indications and contraindications; the collection procedure; storage timing; and special properties of one of its constituents, fetal hemoglobin, in the setting of hypothermic cardiopulmonary bypass.
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Affiliation(s)
- Adam Fernandez
- Perfusion Department, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Kyrylo Chasovskyi
- Perfusion Department, BC Children's Hospital, Vancouver, British Columbia, Canada.
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Vural I, Ozdemir H, Teker G, Yoldemir T, Bilgen H, Ozek E. Delayed cord clamping in term large-for-gestational age infants: A prospective randomised study. J Paediatr Child Health 2019; 55:555-560. [PMID: 30288843 DOI: 10.1111/jpc.14242] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/05/2018] [Accepted: 09/02/2018] [Indexed: 01/16/2023]
Abstract
AIM To compare the post-natal effects of delayed cord clamping (DCC) and early cord clamping (ECC) in term large-for-gestational age (LGA) infants. METHODS This prospective randomised study included 51 term LGA infants. The umbilical cords of these infants were clamped at 15 s in group 1 (ECC group (n = 26)) and at 60 s in group 2 (DCC group (n = 25)). Data for Apgar scores, cord blood, pH and lactate values, second haematocrit, 24th bilirubin levels, duration of hospital stay and admission to the neonatal intensive care unit (NICU) were recorded. RESULTS The demographic characteristics of the infants in the study group were not significantly different. No statistically significant difference was observed in the post-natal haematocrit and bilirubin levels between the groups. Six infants (group 1, n = 3; group 2, n = 3) were diagnosed with polycythaemia (P = 0.79); however, these infants remained asymptomatic, and no treatment was required. One infant in each group developed hyperbilirubinemia, which required phototherapy (P = 1.00). The infant with hyperbilirubinemia in the DCC group presented with asymptomatic polycythaemia. Three neonates in the DCC group required admission to the NICU for transient tachypnoea. CONCLUSIONS No significant increase in the rate of post-natal complications of DCC in term LGA infants was observed in the study. However, before recommending DCC on a routine basis, studies with a larger sample size and long-term follow-up are required to elucidate the risks and benefits of DCC in this group of infants.
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Affiliation(s)
- Irmak Vural
- Department of Pediatrics, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Hulya Ozdemir
- Division of Neonatology, Department of Pediatrics, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Gulsen Teker
- Department of Public Health, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Tevfik Yoldemir
- Department of Obstetrics and Gynecology, Marmara University School of Medicine, Istanbul, Turkey
| | - Hulya Bilgen
- Division of Neonatology, Department of Pediatrics, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Eren Ozek
- Division of Neonatology, Department of Pediatrics, Marmara University Faculty of Medicine, Istanbul, Turkey
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Bahar N, Satar M, Yılmaz M, Büyükkurt S, Özlü F, Yıldızdaş HY, Yaman A. The effects of umblical cord clamping time on lymphocyte subgroups in term and late preterm infants. Turk Arch Pediatr 2019; 53:214-221. [PMID: 30872923 DOI: 10.5152/turkpediatriars.2018.6900] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 08/31/2018] [Indexed: 11/22/2022]
Abstract
Aim To evaluate the effect of umblical cord clamping time on lymphocyte subgroups in term and late preterm infants. Material and Methods Seventy-four infants between 34 and 41 weeks of gestation were included in the study. Of these, 37 were umbilical cord clamped immediately after birth and the remaining 37 were clamped after waiting one minute. Babies were divided into two groups as term and preterm. The prenatal, natal, postnatal characteristics of the infants were recorded. Hematologic and lymphocyte subgroups were investigated in cord blood and venous blood at day 7. Lymphocyte subgroups were evaluated using flow cytometry. Results With the delay of cord clamping, the leucocytes count and the percentage of CD3+T lymphocytes in cord blood of preterm infants decreased and this decrease continued at day 7. On the contrary, CD19+B lymphocyte levels in the cord blood of preterm infants increased, and this increase continued at day 7. Also, the percentage of CD4+T lymphocytes of preterm infants decreased with the delay of cord clamping at day 7. There was no difference between groups for the rate of sepsis development. Conclusion With the delay of cord clamping, the leucocytes count, the percentage of CD3+T, and CD4+T lymphocytes decreased, and the percentage of CD19+B lymphocytes increased in preterm infants. The delay in cord clamping time in term and preterm infants seems to have no impact on the rate of sepsis development. Larger series of studies are needed to assess the effect of these findings on the development of infection in late preterm infants who have delayed cord clamping.
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Affiliation(s)
- Nilgün Bahar
- Department of Pediatrics, Çukurova University School of Medicine, Adana, Turkey
| | - Mehmet Satar
- Department of Pediatrics, Division of Neonatology, Çukurova University School of Medicine, Adana, Turkey
| | - Mustafa Yılmaz
- Department of Pediatrics, Division of Pediatric Allergy and Immunology, Çukurova University School of Medicine, Adana, Turkey
| | - Selim Büyükkurt
- Department of Gynecology and Obstetrics, Çukurova University School of Medicine, Adana, Turkey
| | - Ferda Özlü
- Department of Pediatrics, Division of Neonatology, Çukurova University School of Medicine, Adana, Turkey
| | - Hacer Yapıcıoğlu Yıldızdaş
- Department of Pediatrics, Division of Neonatology, Çukurova University School of Medicine, Adana, Turkey
| | - Akgün Yaman
- Central Laboratory, Çukurova University, Balcalı Hospital, Adana, Turkey
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Begley CM, Gyte GML, Devane D, McGuire W, Weeks A, Biesty LM. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev 2019; 2:CD007412. [PMID: 30754073 PMCID: PMC6372362 DOI: 10.1002/14651858.cd007412.pub5] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Active management of the third stage of labour involves giving a prophylactic uterotonic, early cord clamping and controlled cord traction to deliver the placenta. With expectant management, signs of placental separation are awaited and the placenta is delivered spontaneously. Active management was introduced to try to reduce haemorrhage, a major contributor to maternal mortality in low-income countries. This is an update of a review last published in 2015. OBJECTIVES To compare the effects of active versus expectant management of the third stage of labour on severe primary postpartum haemorrhage (PPH) and other maternal and infant outcomes.To compare the effects of variations in the packages of active and expectant management of the third stage of labour on severe primary PPH and other maternal and infant outcomes. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the World health Organization International Clinical Trials Registry Platform (ICTRP), on 22 January 2018, and reference lists of retrieved studies. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing active versus expectant management of the third stage of labour. Cluster-randomised trials were eligible for inclusion, but none were identified. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the studies for inclusion, assessed risk of bias, carried out data extraction and assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included eight studies, involving analysis of data from 8892 women. The studies were all undertaken in hospitals, seven in higher-income countries and one in a lower-income country. Four studies compared active versus expectant management, and four compared active versus a mixture of managements. We used a random-effects model in the analyses because of clinical heterogeneity. Of the eight studies included, we considered three studies as having low risk of bias in the main aspects of sequence generation, allocation concealment and completeness of data collection. There was an absence of high-quality evidence according to GRADE assessments for our primary outcomes, which is reflected in the cautious language below.The evidence suggested that, for women at mixed levels of risk of bleeding, it is uncertain whether active management reduces the average risk of maternal severe primary PPH (more than 1000 mL) at time of birth (average risk ratio (RR) 0.34, 95% confidence interval (CI) 0.14 to 0.87, 3 studies, 4636 women, I2 = 60%; GRADE: very low quality). For incidence of maternal haemoglobin (Hb) less than 9 g/dL following birth, active management of the third stage may reduce the number of women with anaemia after birth (average RR 0.50, 95% CI 0.30 to 0.83, 2 studies, 1572 women; GRADE: low quality). We also found that active management of the third stage may make little or no difference to the number of babies admitted to neonatal units (average RR 0.81, 95% CI 0.60 to 1.11, 2 studies, 3207 infants; GRADE: low quality). It is uncertain whether active management of the third stage reduces the number of babies with jaundice requiring treatment (RR 0.96, 95% CI 0.55 to 1.68, 2 studies, 3142 infants, I2 = 66%; GRADE: very low quality). There were no data on our other primary outcomes of very severe PPH at the time of birth (more than 2500 mL), maternal mortality, or neonatal polycythaemia needing treatment.Active management reduces mean maternal blood loss at birth and probably reduces the rate of primary blood loss greater than 500 mL, and the use of therapeutic uterotonics. Active management also probably reduces the mean birthweight of the baby, reflecting the lower blood volume from interference with placental transfusion. In addition, it may reduce the need for maternal blood transfusion. However, active management may increase maternal diastolic blood pressure, vomiting after birth, afterpains, use of analgesia from birth up to discharge from the labour ward, and more women returning to hospital with bleeding (outcome not pre-specified).In the comparison of women at low risk of excessive bleeding, there were similar findings, except it was uncertain whether there was a difference identified between groups for severe primary PPH (average RR 0.31, 95% CI 0.05 to 2.17; 2 studies, 2941 women, I2 = 71%), maternal Hb less than 9 g/dL at 24 to 72 hours (average RR 0.17, 95% CI 0.02 to 1.47; 1 study, 193 women) or the need for neonatal admission (average RR 1.02, 95% CI 0.55 to 1.88; 1 study, 1512 women). In this group, active management may make little difference to the rate of neonatal jaundice requiring phototherapy (average RR 1.31, 95% CI 0.78 to 2.18; 1 study, 1447 women).Hypertension and interference with placental transfusion might be avoided by using modifications to the active management package, for example, omitting ergot and deferring cord clamping, but we have no direct evidence of this here. AUTHORS' CONCLUSIONS Although the data appeared to show that active management reduced the risk of severe primary PPH greater than 1000 mL at the time of birth, we are uncertain of this finding because of the very low-quality evidence. Active management may reduce the incidence of maternal anaemia (Hb less than 9 g/dL) following birth, but harms such as postnatal hypertension, pain and return to hospital due to bleeding were identified.In women at low risk of excessive bleeding, it is uncertain whether there was a difference between active and expectant management for severe PPH or maternal Hb less than 9 g/dL (at 24 to 72 hours). Women could be given information on the benefits and harms of both methods to support informed choice. Given the concerns about early cord clamping and the potential adverse effects of some uterotonics, it is critical now to look at the individual components of third-stage management. Data are also required from low-income countries.It must be emphasised that this review includes only a small number of studies with relatively small numbers of participants, and the quality of evidence for primary outcomes is low or very low.
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Affiliation(s)
- Cecily M Begley
- Trinity College DublinSchool of Nursing and Midwifery24 D'Olier StreetDublinIreland
| | - Gillian ML Gyte
- University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Declan Devane
- National University of Ireland GalwaySchool of Nursing and MidwiferyUniversity RoadGalwayIreland
| | - William McGuire
- University of YorkCentre for Reviews and DisseminationYorkY010 5DDUK
| | - Andrew Weeks
- The University of LiverpoolDepartment of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Linda M Biesty
- National University of Ireland GalwaySchool of Nursing and MidwiferyUniversity RoadGalwayIreland
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Rana N, Kc A, Målqvist M, Subedi K, Andersson O. Effect of Delayed Cord Clamping of Term Babies on Neurodevelopment at 12 Months: A Randomized Controlled Trial. Neonatology 2019; 115:36-42. [PMID: 30278462 DOI: 10.1159/000491994] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Delayed cord clamping (DCC) is associated with an improved iron status at 8 months, a reduction of anemia at 12 months, and an improved development at 4 years. Assessment of the development after DCC has not been performed earlier in a setting with a high prevalence of iron deficiency. OBJECTIVE The aim of this paper was to investigate the effects of DCC compared to early cord clamping (ECC) on the development evaluated with the Ages and Stages Questionnaire (ASQ) at 12 months of age. METHOD We conducted a randomized controlled trial investigating the effect of DCC (≥180 s) versus ECC (≤60 s) in 540 full-term deliveries. Twelve months after delivery, the parents reported their infant's development by ASQ. Infants having a score < 1 standard deviation (SD) under the mean score were considered "at risk" of affected neurodevelopment. RESULTS At 12 months of age, 332 (61.5%) infants were assessed. Fewer children in the DCC group were "at risk" of having affected neurodevelopment measured by the ASQ total score, 21 (7.8%) versus 49 (18.1%) in the ECC group. The relative risk was 0.43 (0.26-0.71). Infants in the DCC group had higher mean total scores (SD), 290.4 (10.4) versus 287.2 (10.1), p = 0.01. Significantly fewer infants in the delayed group were "at risk" and had higher scores in the domains "communication", "gross motor", and "personal-social". CONCLUSIONS DCC after 3 min was associated with an improvement of the overall neurodevelopment assessed at 12 months of age as compared to infants in the group with cord clamping within 1 min.
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Affiliation(s)
- Nisha Rana
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Life Line Nepal, Thapathali, Kathmandu, Nepal
| | - Ashish Kc
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Health Section, UNICEF, UN House, Lalitpur, Nepal
| | - Mats Målqvist
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Kalpana Subedi
- Paropakar Maternity and Women's Hospital, Kathmandu, Nepal
| | - Ola Andersson
- Department of Women's and Children's Health, Uppsala University, Uppsala, .,Department of Research and Development, Region Halland, Halmstad,
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Jain R, Jain A, Devgan V, Sekhar J. Effect of alternative positions of neonates prior to delayed cord clamping on placental transfusion: a randomized control trial. J Matern Fetal Neonatal Med 2018; 33:1511-1516. [PMID: 30185106 DOI: 10.1080/14767058.2018.1520834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Objective: To determine the effect of alternative positions (relative to placenta) of normal term neonates, prior to the recommended delayed cord clamping, on placental transfusion and short-term neonatal outcome.Methods: Normal term neonates born vaginally were randomly assigned to be placed either on mother's abdomen (Group AL, n = 97) or 20 cm below the introitus (Group BL, n = 102) for 90 seconds after delivery. Subsequently the cord was clamped. Outcome measures were anthropometry, hematological profile including ferritin at birth and at 3-4 months; and adverse effects, polycythemia, and jaundice.Results: Both groups had comparable outcome measures at birth. At 3-4 months, mean hemoglobin (AL: 12.0 ± 0.9 g/dl, BL: 12.3 ± 1.1 g/dl; p = .02, 95% CI: 0.03-0.58) and hematocrit (AL: 36.1 ± 2.7%, BL: 37 ± 3.2%; p = .01, 95% CI: 0.1-1.75) were significantly higher in BL group. Anthropometry, serum ferritin, incidence of anemia and iron deficiency at 3-4 months were similar in both groups. There was no significant difference in polycythemia, jaundice requiring phototherapy or respiratory distress between the two groups.Conclusions: Placing the baby below the placenta resulted in a statistically significant increase in hemoglobin and hematocrit at 3-4 months without any adverse outcomes. However, this meager quantum of increase did not translate into reduction of risk of anemia or improvement in iron stores.
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Affiliation(s)
- Ridhimaa Jain
- Department of Pediatrics, Hindu Rao Hospital, New Delhi, India
| | - Ashish Jain
- Department of Neonatology, Maulana Azad Medical College, New Delhi, India
| | - Veena Devgan
- Department of Pediatrics, Hindu Rao Hospital, New Delhi, India
| | - Jerin Sekhar
- Department of Pediatrics, Maulana Azad Medical College, ITO, New Delhi, India
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