The timing of cord clamping and oxidative stress in term newborns

Comparison of Three Different Cord Clamping Techniques Regarding Oxidative-Antioxidative Capacity in Term Newborns

OBJECTIVE

As newborns are exposed to oxidative stress during delivery, cord clamping techniques play significant role on antioxidant status. In this study, we aimed to show the relationship between early cord clamping (ECC), delayed cord clamping (DCC), and cut-umbilical cord milking (C-UCM) techniques with total oxidant capacity (TOC), total antioxidant capacity (TAC), and peroxynitrite levels.

STUDY DESIGN

Sixty-nine term infants were selected with Apgar's score of 7 and above in the 1 minute and 5 minutes. The mothers of all infants had uncomplicated pregnancy, had no congenital anomaly, and delivered by cesarean section. Newborns were randomized to one of three groups: ECC (n: 23), DCC (n: 23), or C-UCM (n: 23). After all newborn babies were taken under radiant heater, blood samples were collected from the UC. The plasma samples were then frozen and stored at -80°C until analysis and TOC, TAC, and peroxynitrite levels were studied.

RESULTS

The ages of the mothers participating in the study were between 17 and 42 years, with an average of 29.14 ± 6.28. Thirty (43.5%) of the babies were girls and 39 (56.5%) were boys. The 5-minute Apgar's score of the babies in ECC group was significantly lower than the babies in DCC and cut cord milking group (p = 0.034; p = 0.034; p < 0.05). The TOC, oxidative stress index (OSI), and peroxynitrite measurements of three groups did not differ statistically. The TAC value of the C-UCM group was significantly higher than the patients with the ECC and DCC groups (p = 0.002; p = 0.019; p < 0.05).

CONCLUSION

C-UCM and DCC would be feasible methods by increasing antioxidant status and providing protective effect on the future health of the term newborns.

KEY POINT

· Cord clamping techniques play significant role on antioxidant status of the newborn babies.. · C-UCM and DCC are feasible methods for term newborns.. · Cord clamping methods may play a protective effect on the future health of term newborns..

Umbilical cord clamping time and maternal satisfaction

OBJECTIVE

Clamping of the umbilical cord is part of the third stage of delivery. Delayed cord clamping (DCC) is recommended due to its contribution to prevention of anaemia. There is no evidence on the effect of DCC on maternal satisfaction. The aim of this study is to evaluate the effect of different sociodemographic and obstetric factors, including the timing of cord clamping, on maternal satisfaction with the birth experience in our healthcare system.

DESIGN

Pragmatic non-drug intervention study with simple random assignment of participating mothers (Clinical Trials N°: NCT03624335).

SETTING

A public, university-level hospital in Villarreal city, eastern Spain.

PARTICIPANTS

Childbearing woman, gestation week between 35 and 42 weeks, with regular medical pregnancy checks, single pregnancy and vaginal delivery (N = 198, 80% of the women recruited).

INTERVENTIONS

umbilical cord clamping within 60 seconds of the birth (Early cord clamping, ECC) versus umbilical cord clamping after pulsation had been ceased (Delayed cord clamping, DCC).

MEASUREMENTS

Birth satisfaction was measured using the Mackey Childbirth Satisfaction Rating Scale (MCSRS). Additionally, sociodemographic data, degree of knowledge about the moment of clamping and type of breastfeeding data were recorded. The Mann-Whitney and Kruskal-Wallis tests for comparison of the mean of two, three, or more groups, respectively, and Chi-square and Spearman for comparison of two qualitative and quantitative variables, respectively, were used. To determine the weight of each factor of MCSRS, an exploratory factor analysis was carried out using the maximum likelihood method for factor extraction and the varimax method for factor rotation. The adequacy of the factor analysis was checked by mean of Kaiser-Meyer-Olkin test and Bartlett sphericity test. The level of significance was set at a p-value of < 0.05.

FINDINGS

The average degree of satisfaction was 4.55/5 (SD: 0.37). No statistically significant difference was observed between mothers' satisfaction according to mother level of study or mother's place of birth, while it changed significantly with age (p = 0.0398). Within the obstetric variables, satisfaction was significantly associated with spontaneous amniorrhexis, the duration of the second stage of delivery, and the Apgar value of the newborn at the first minute of life, and was independent of the number of previous pregnancies and deliveries, use of intrapartum oxytocin, epidural analgesia, episiotomy, the weight of the child at birth and type of breastfeeding. Furthermore, there was no relationship between the time of clamping and satisfaction (p = 0.5178).

KEY CONCLUSIONS

Maternal satisfaction with the birth experience varies with the age of the childbearing woman, and some intrapartum factors and the result is not influenced by the time of clamping of the umbilical cord. Therefore, this component of the physiological management of childbirth provides additional benefits for the health of the neonate, without negative consequences on the final perception of the maternal health care received.

IMPLICATIONS FOR PRACTICE

If there are no reasons that justify an early umbilical cord clamping, delaying it brings benefits to the neonate, without negatively affecting the maternal assessment of the experience of childbirth.

Anticancer activity of β-Lapachone derivatives on human leukemic cell lines

β-lapachone is a 1,2-naphthoquinone of great therapeutic interest that induces cell death by autophagy and apoptosis in tumor cells due to oxidative stress increasing. However, its high toxicity in healthy tissues limits its clinical use, which stimulates the planning and synthesis of more selective analogs. The aim of this study was to investigate the cytotoxic activity of three thiosemicarbazones derived from β-lapachone (BV2, BV3 and BV5) in leukemia cells. Cytotoxicity tests were performed on tumor cells (HL-60, K562, K562-Lucena and MOLT-4) and normal peripheral blood mononuclear cells (PBMCs). Subsequently, the mode of action of compounds was accessed by optical microscopy, transmission electron microscopy or fluorescence microscopy. Flow cytometry analysis was performed to investigate apoptosis induction, cell cycle, DNA fragmentation and mitochondrial depolarization. All derivatives inhibited tumor cell growth after 72 h (IC₅₀ < 10 μM to all cell lines, including the resistant K562-Lucena) with less toxic effects in PBMC cells, being BV3 the most selective compound with selective index (SI) of 275 for HL-60; SI of 40 to K562; SI of 10 for MOLT-4 and SI of 50 to K562-Lucena compared to β-lapachone with SI of 18 to HL-60, SI of 3.7 to K562; SI of 2.4 to MOLT-4 and SI of 0.9 to K562-Lucena. In addition, the K562 or MOLT-4 cells treated with BV3 showed characteristics of both apoptosis and autophagy cell death, mainly by autophagy. These results demonstrate the potent cytotoxic effect of thiosemicarbazones derived from β-lapachone as promising anticancer drugs candidates, encouraging the continuity of in vivo tests.

Cord Management of the Term Newborn

Keeping the umbilical cord intact after delivery facilitates transition from fetal to neonatal circulation and allows a placental transfusion of a considerable amount of blood. A delay of at least 3 minutes improves neurodevelopmental outcomes in term infants. Although regarded as common sense and practiced by many midwives, implementation of delayed cord clamping into practice has been unduly slow, partly because of beliefs regarding theoretic risks of jaundice and lack of understanding regarding the long-term benefits. This article provides arguments for delaying cord clamping for a minimum of 3 minutes.

Oxidative stress and peripartum outcomes (Review)

Pregnancy, labor and childbirth are accompanied by excessive oxidative aggression. The excessive formation of free radicals [reactive oxygen species (ROS), reactive nitrogen species (RNS), chlorine reactive species (CRS)] causes cellular oxidative damage, which can be scavenged by enzymatic or non-enzymatic antioxidants in normal healthy pregnancy, physiological labor and delivery without any complications. An imbalance between the pro-oxidant and antioxidant factors may lead to oxidative stress, which contributes to the development of many diseases. This oxidative aggression can be a precursor for pathologies in the pregnant woman including eclampsia, miscarriage, preterm labor, and intrauterine growth retardation; in the offspring it may lead to bronchopulmonary dysplasia/chronic lung disease, necrotizing enterocolitis, retinopathy of prematurity, and periventricular leukomalacia. This review summarizes the studies conducted to identify the mechanisms of oxidative stress and the effect of cell membrane oxidation, the mechanisms that are behind oxidative stress-related diseases, and also those studies which have demonstrated the effect of antioxidants in preventing diseases or diminishing the effects of oxidative stress in the body, in obstetrics and neonatology.

Delayed cord clamping in healthy term infants: More harm or good?

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.

Oxygen and pulmonary vasodilation: The role of oxidative and nitrosative stress

Respiratory failure complicates up to 2% of live births and contributes significantly to neonatal morbidity and mortality. Under these conditions, supplemental oxygen is required to support oxygen delivery to the brain and other organs, and to prevent hypoxic pulmonary vasoconstriction. However, therapeutic oxygen is also a source of reactive oxygen species that produce oxidative stress, along with multiple intracellular systems that contribute to the production of free radicals in pulmonary endothelium and vascular smooth muscle. These free radicals cause vasoconstriction, act on multiple sites of the nitric oxide pathway to reduce cGMP-mediated vasodilation, and nitrate and inactivate essential proteins such as surfactant. In addition to oxygen, antenatal stressors such as placental insufficiency, maternal diabetes, and fetal growth restriction increase pulmonary and vascular oxidant stress and may amplify the adverse effects of oxygen. Moreover, the effects of free radical damage may extend well beyond infancy as suggested by the increased risk of childhood malignancy after neonatal exposure to hyperoxia. Antioxidant therapy is theoretically promising, but there are not yet clinical trials to support this approach. Targeting the abnormal sources of increased oxidant stress that trigger abnormal pulmonary vascular responses may be more effective in treating disease and preventing long term consequences.

Placental Transfusion for Asphyxiated Infants

The current recommendation for umbilical cord management of non-vigorous infants (limp, pale, and not breathing) who need resuscitation at birth is to immediately clamp the umbilical cord. This recommendation is due in part to insufficient evidence for delayed cord clamping (DCC) or umbilical cord milking (UCM). These methods may provide a neuroprotective mechanism that also facilitates cardiovascular transition for non-vigorous infants at birth.

Short-term ubiquinol supplementation reduces oxidative stress associated with strenuous exercise in healthy adults: A randomized trial

Studies about Coenzyme Q₁₀ (CoQ₁₀ ) supplementation on strenuous exercise are scarce, especially those related with oxidative stress associated with physical activity and virtually nonexistent with the reduced form, Ubiquinol. The objective of this study was to determine, for the first time, whether a short-term supplementation with Ubiquinol can prevent oxidative stress associated to strenuous exercise. The participants (n = 100 healthy and well trained, but not on an elite level) were classified in two groups: Ubiquinol (experimental group), and placebo group (control). The protocol consisted of conducting two identical strenuous exercise tests with a rest period between tests of 24 h. Blood and urine samples were collected from the participants before supplementation (basal value) (T1), after supplementation (2 weeks) (T2), after first physical exercise test (T3), after 24 h of rest (T4), and after second physical exercise test (T5).The increase observed in the lactate, isoprostanes, DNA damage, and hydroperoxide levels reveals the severity of the oxidative damage induced by the exercise. There was a reduction in the isoprostanes, 8-OHdG, oxidized LDL, and hydroperoxydes in the supplemented Ubiquinol group, an increase in total antioxidant status, fat soluble antioxidant (both plasma and membrane), and CAT activity. Also, NO in the Ubiquinol-supplemented group was maintained within a narrow range. Oxidative stress induced by strenuous exercise is accumulative and increases transiently in subsequent sessions of physical activity. A short-term supplementation (2 weeks) with Ubiquinol (200 mg/day) before strenuous exercise, decreases oxidative stress and increases plasma NO, fact that could improve endothelial function, energetic substrate supply, and muscle recovery after strenuous exercise. © 2016 BioFactors, 42(6):612-622, 2016.

Omega-3 LCPUFA supplement: a nutritional strategy to prevent maternal and neonatal oxidative stress

There is controversy about fish-oil supplementation and oxidative damage. This ambiguity should be explored to elucidate its role as modulator of oxidative stress, especially during gestation and postnatal life. This is the objective of this study. One hundred ten pregnant women were divided in two groups: control group CT (400 mL/day of the control dairy drink); supplemented group FO (400 mL/day of the fish oil-enriched dairy drink (±400-mg EPA-DHA/day)). Different biomarkers of oxidative damage were determined in the mother's at enrolment, at delivery and at 2.5 and 4 months postpartum and newborns at delivery and at 2.5 months postpartum. Omega-3 LC-PUFA supplementation during pregnancy and lactation decreased plasma hydroperoxides especially in newborn at delivery (P = 0.001) and 2.5 months (P = 0.006), increased superoxide dismutase (SOD) and catalase (CAT) in mothers at delivery (P = 0.024 (SOD)) and after 2.5 months (P = 0.040 (CAT)) and in newborns at 2.5 months (P = 0.035 (SOD); P = 0.021 (CAT)). Also, supplementation increased α-tocoferol in mothers at 2.5 months (P = 0.030) and in umbilical cord artery (P = 0.039). Higher levels of CoQ10 were found in mothers at delivery (P = 0.039) as well as in umbilical cord vein (P = 0.024) and artery (P = 0.036). Our supplementation prevents the oxidative stress in the mother and neonate during the first months of postnatal life, being a potential preventive nutritional strategy to prevent functional alterations associated with oxidative stress that have an important repercussion for the neonate development in the early postnatal life.

[Evaluation of the measurement of hemoglobin by the Hemocue System® in the preterm neonate less than 28 days old]

BACKGROUND

Hemoglobin (Hb) measurement is essential for the monitoring of anemia in preterm neonates to assess if any bleeding (pulmonary, cerebral, digestive) is present. EDTA samples require 500 μL vs. 10 μL for the Hemocue(®) system. This system has been evaluated and validated in adults and children but not in preterm neonates with fetal hemoglobin. The aim of the study was to compare Hb measurement with the Hemocue(®) system vs. the EDTA laboratory system on fetal Hb in preterm neonates.

MATERIALS AND METHODS

This was a prospective study conducted in the preterm intensive care unit in the Amiens Hospital. Preterm neonates, before 28 days of life, requiring EDTA (Hb) measurement were included. Two Hemocues(®) were performed at the same time. Postnatal age (correlated to the fetal hemoglobin level decrease), blood sample site, and other factors that could influence the Hb result were evaluated.

RESULTS

Seventy-six EDTA and 152 Hemocue(®) samples from 38 preterm neonates were included. The term was 28.1±3.7 weeks of gestation, the birth weight was 1215.5±657 g. We found a good correlation between the Hemocue(®) and EDTA samples (Hemocue(®)=EDTA*0.94-0.4; R(2)=0.63; P<0.001). The influence of confounding factors was insignificant.

CONCLUSION

The use of the Hemocue(®) system showed a good correlation with the EDTA measurement of fetal Hb, with a moderate bias (-0.2±1.5 g/dL), which remained stable for the first 28 days of life.