scholarly journals Oxygen saturation and heart rate in healthy term and late preterm infants with delayed cord clamping

2022 ◽  
Author(s):  
Inmaculada Lara-Cantón ◽  
Shiraz Badurdeen ◽  
Janneke Dekker ◽  
Peter Davis ◽  
Calum Roberts ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Preterm Infants ◽  
Left Ventricular ◽  
Late Preterm ◽  
Arterial Oxygen ◽  
Reference Ranges ◽  
Delayed Cord Clamping ◽  
Late Preterm Infants ◽  
Cord Clamping ◽  
Neonatal Transition

Abstract Blood oxygen in the fetus is substantially lower than in the newborn infant. In the minutes after birth, arterial oxygen saturation rises from around 50–60% to 90–95%. Initial respiratory efforts generate negative trans-thoracic pressures that drive liquid from the airways into the lung interstitium facilitating lung aeration, blood oxygenation, and pulmonary artery vasodilatation. Consequently, intra- (foramen ovale) and extra-cardiac (ductus arteriosus) shunting changes and the sequential circulation switches to a parallel pulmonary and systemic circulation. Delaying cord clamping preserves blood flow through the ascending vena cava, thus increasing right and left ventricular preload. Recently published reference ranges have suggested that delayed cord clamping positively influenced the fetal-to-neonatal transition. Oxygen saturation in babies with delayed cord clamping plateaus significantly earlier to values of 85–90% than in babies with immediate cord clamping. Delayed cord clamping may also contribute to fewer episodes of brady-or-tachycardia in the first minutes after birth, but data from randomized trials are awaited. Impact Delaying cord clamping during fetal to neonatal transition contributes to a significantly earlier plateauing of oxygen saturation and fewer episodes of brady-and/or-tachycardia in the first minutes after birth. We provide updated information regarding the changes in SpO2 and HR during postnatal adaptation of term and late preterm infants receiving delayed compared with immediate cord clamping. Nomograms in newborn infants with delayed cord clamping will provide valuable reference ranges to establish target SpO2 and HR in the first minutes after birth.

scholarly journals Milking of the Umbilical Cord in Term and Late Preterm Infants

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Stefano Basile ◽  
Sara Pinelli ◽  
Elisabetta Micelli ◽  
Marta Caretto ◽  
Pierluigi Benedetti Panici
Keyword(s):  
Preterm Infants ◽  
Umbilical Cord ◽  
Time Frame ◽  
Late Preterm ◽  
Delayed Cord Clamping ◽  
Late Preterm Infants ◽  
Positive Effects ◽  
Cord Clamping ◽  
Number Of Patients ◽  
Umbilical Cord Milking

Introduction. Umbilical cord milking is a procedure in which clamped or unclamped umbilical cord is grasped, and blood is pushed (“stripped”) two to four times towards the newborn, in a rapid time frame, usually within 20 seconds. The target of umbilical cord milking is to provide infants with their whole potential blood volume—of which they are deprived when early cord clamping is carried out—completing placental transfusion in a shorter time than delayed cord clamping. The aim of this narrative review is to analyse the literature regarding umbilical cord milking in term and late-preterm infants and to assess all possible benefits and limits of this procedure in clinical practice, especially in comparison to immediate and delayed cord clamping.Methods. We analysed literature data concerning maternal, as well as neonatal, outcomes for term and late-preterm (gestational age ≥ 34 weeks) newborns who received umbilical cord milking.Results. Most studies show comparable benefits for both umbilical cord milking and delayed cord clamping, especially in terms of haematological parameters when compared to immediate cord clamping. Umbilical cord milking may be a feasible procedure also for newborns requiring resuscitation.Conclusions. Literature data concerning positive effects of umbilical cord milking are encouraging and suggest that umbilical cord milking may be a quick and effective method to provide placental transfusions to depressed infants. However, the lack of standardised procedures and the variation in evaluated outcomes as well as the limited number of patients enrolled in trials, along with the retrospective nature of some of them, prevent recommending umbilical cord milking as a routine procedure.

Effects of Placental Transfusion on Late Preterm Infants Admitted to a Mother Baby Unit

2021 ◽  
Author(s):  
Arpitha Chiruvolu ◽  
Reshma George ◽  
Karen C. Stanzo ◽  
Cassandra M. Kindla ◽  
Sujata Desai
Keyword(s):  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Guideline Implementation ◽  
Hospital Length ◽  
Late Preterm ◽  
Hospital Length Of Stay ◽  
Delayed Cord Clamping ◽  
Late Preterm Infants ◽  
Cord Clamping ◽  
Key Points

Objective Well-appearing late preterm infants admitted to a mother baby unit may benefit from either delayed cord clamping (DCC) or umbilical cord milking (UCM). However, there are concerns of adverse effects of increased blood volume such as polycythemia and hyperbilirubinemia. The purpose of this study is to examine the short-term effects of placental transfusion on late preterm infants born between 350/7 and 366/7 weeks of gestation.Study Design In this pre- and postimplementation retrospective cohort study, we compared late preterm infants who received placental transfusion (161 infants, DCC/UCM group) during a 2-year period after guideline implementation (postimplementation period: August 1, 2017 to July 31, 2019) to infants who had immediate cord clamping (118 infants, ICC group) born during a 2-year period before implementation (preimplementation period: August 1, 2015 to July 31, 2017).Results The mean hematocrit after birth was significantly higher in the DCC/UCM group. Fewer infants had a hematocrit <40% after birth in the DCC/UCM group compared with the ICC group. The incidence of hyperbilirubinemia needing phototherapy, neonatal intensive care unit (NICU) admissions, or readmissions to the hospital for phototherapy was similar between the groups. Fewer infants in the DCC/UCM group were admitted to the NICU primarily for respiratory distress. Symptomatic polycythemia did not occur in either group. Median hospital length of stay was 3 days for both groups.Conclusion Placental transfusion (DCC or UCM) in late preterm infants admitted to a mother baby unit was not associated with increased incidence of hyperbilirubinemia needing phototherapy, symptomatic polycythemia, NICU admissions, or readmissions to the hospital for phototherapy.Key Points

Myocardial function in late preterm infants during the transitional period: comprehensive appraisal with deformation mechanics and non-invasive cardiac output monitoring

2019 ◽  
Vol 30 (2) ◽  
pp. 249-255
Author(s):  
Alessia Cappelleri ◽  
Neidin Bussmann ◽  
Susan Harvey ◽  
Phillip T. Levy ◽  
Orla Franklin ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Stroke Volume ◽  
Preterm Infants ◽  
Left Ventricular ◽  
Late Preterm ◽  
Cardiac Output Monitoring ◽  
Late Preterm Infants ◽  
Non Invasive ◽  
Left Ventricular Output ◽  
Output Monitoring

AbstractBackground:There is a paucity of functional data on mid-to-late preterm infants between 30+0 and 34+6 weeks gestation. We aimed to characterise transitional cardiopulmonary and haemodynamic changes during the first 48 hours in asymptomatic mid-to-late preterm infants.Methods:Forty-five healthy preterm newborns (mean ± standard deviation) gestation of 32.7 ± 1.2 weeks) underwent echocardiography on Days 1 and 2. Ventricular mechanics were assessed by speckle tracking-derived deformation, rotational mechanics, tissue Doppler imaging, and right ventricle-focused measures (tricuspid annular plane systolic excursion, fractional area change). Continuous haemodynamics were assessed using the NICOM™ system to obtain left ventricular output, stroke volume, heart rate, and total peripheral resistance by non-invasive cardiac output monitoring.Results:Right ventricular function increased (all measures p < 0.005) with mostly stable left ventricular performance between Day 1 and Day 2. NICOM-derived left ventricular output [mean 34%, 95% confidence interval 21–47%] and stroke volume [29%, 16–42%] increased with no change in heart rate [5%, −2 to 12%]. There was a rise in mean blood pressure [11%, 1–21%], but a decline in total peripheral resistance [−14%, −25 to −3%].Conclusion:Left ventricular mechanics remained persevered in mid-to-late premature infants, but right ventricular function increased. Non-invasive cardiac output monitoring is feasible in preterm infants with an increase in left ventricular output driven by an improvement in stroke volume during the transitional period.

scholarly journals The effects of umblical cord clamping time on lymphocyte subgroups in term and late preterm infants

2019 ◽  
Vol 53 (4) ◽  
pp. 214-221 ◽  
Author(s):  
Nilgun Bahar ◽  
◽  
Mehmet Satar ◽  
Mustafa Yilmaz ◽  
Selim Buyukkurt ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Late Preterm ◽  
Late Preterm Infants ◽  
Cord Clamping

Is Delaying Cord Clamping until Placenta Delivery Beneficial? Oxygen Saturation and Heart Rate Transition during the Initial 5 Minutes after Delivery in Indian Healthy Newborns

2019 ◽  
Vol 37 (07) ◽  
pp. 738-744 ◽  
Author(s):  
Suchandra Mukherjee ◽  
Jignesh S. Bulsara ◽  
Manoja Kumar Das ◽  
Yogendra Waratakar ◽  
Anindya Kumar Saha ◽  
...  
Keyword(s):  
Heart Rate ◽  
Caesarean Section ◽  
Observational Study ◽  
Oxygen Saturation ◽  
Prospective Observational Study ◽  
West Bengal ◽  
Reference Ranges ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Early Cord Clamping

Objective This study aimed to compare the preductal oxygen saturation (SpO2) and heart rate (HR) in newborns during the initial 5 minutes after birth with delayed cord clamping (DCC) and early cord clamping (ECC) practices at sea level. Study Design This prospective observational study included newborns born at >34 weeks vaginally (Dharampur, Gujarat) or through caesarean section (CS) (Kolkata, West Bengal). In Dharampur, the newborns received ECC practice (8 weeks) followed by DCC practice (10 weeks). In Kolkata, the newborns received ECC practice only (8 weeks). Results The newborns with DCC (n = 170) had significantly higher SpO2 (3–8%) throughout than those with ECC born either vaginally (n = 178) or through CS (n = 101). The newborns with DCC had slower rise in HR during the first 2 minutes than those with ECC. The 5th and 10th percentile values of SpO2 for newborns with DCC practice were higher than those with ECC practice. Conclusion The trends of SpO2 and HR during the first 5 minutes after birth indicate a relatively smoother cardiopulmonary transition by delaying cord clamping till placental delivery compared with early clamping. The reference ranges can be used for Indian newborns born by uncomplicated vaginal delivery with DCC during the first 5 minutes.

scholarly journals Correlation between Perfusion Index and Left Ventricular Output in Healthy Late Preterm Infants

2021 ◽  
Author(s):  
Nilay Hakan ◽  
Ayça Aytekin ◽  
Özkan İlhan ◽  
Mustafa Aydin ◽  
Haşim Olgun
Keyword(s):  
Preterm Infants ◽  
Left Ventricular ◽  
Perfusion Index ◽  
Late Preterm ◽  
Microvascular Blood Flow ◽  
Systemic Hemodynamic ◽  
Late Preterm Infants ◽  
Preterm Babies ◽  
Left Ventricular Output ◽  
The Mean

Abstract The perfusion index (PI) is a noninvasive marker derived from photoelectric plethysmographic signals in pulse oximetry in the evaluation of peripheral perfusion. This study was aimed to determine the correlation between PI and left ventricular output (LVO) in healthy late preterm infants at 48th hour of life. With new generation pulse oximeter [MASIMO Rad 7 Oximeter] pre- and post-ductal PI values were recorded from healthy late preterm babies at the 48th hour of life. PI was determined simultaneously with LVO as measured by transthoracic echocardiography. A total of 50 late preterm babies were included in the study. The mean gestational age of the cases was 35.4 ± 0.7 weeks and the birth weight was 2586 ± 362 g. Mean pre- and post-ductal PI values at the postnatal 48th hour of babies’ life were found to be 2.0 ± 0.9 and 1.7 ± 1.1. The mean LVO value was 438 ± 124, LVO/kg 175 ± 50. When the LVO value was normalized according to the babies’ body weight, there was no statistically significant correlation between the pre- and post-ductal PI and the LVO / kg value (r < 0.2, p > 0.05 in both comparisons). Conclusion: There was no correlation between pre- and post-ductal PI and LVO values in healthy late preterm infants. This may be due to the failure of the LVO, a systemic hemodynamic parameter, to accurately reflect microvascular blood flow due to incomplete maturation of the sympathetic nervous system involved in the regulation of peripheral tissue perfusion in preterm babies.

scholarly journals Haematocrit in <35 weeks preterm infants who received at least 60 seconds of delayed cord clamping: a retrospective observational study

2019 ◽  
Vol 3 (1) ◽  
pp. e000531
Author(s):  
Matthew JR Nudelman ◽  
Keshav Goel ◽  
Priya Jegatheesan ◽  
Dongli Song ◽  
Angela Huang ◽  
...  
Keyword(s):  
Observational Study ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Standard Of Care ◽  
Retrospective Observational Study ◽  
Secondary Outcome ◽  
Reference Ranges ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
The Mean

ObjectiveTo describe haematocrit at birth in preterm infants who received ≥60 s of delayed cord clamping (DCC).DesignRetrospective observational study.SettingA California public hospital with an American Academy of Pediatrics level 4 neonatal intensive care unit, with 3500–4000 deliveries annually.Participants467 preterm infants born at <35 weeks’ gestational age (GA) between January 2013 and December 2018.Primary and secondary outcome measuresHaematocrit reference ranges for 0–4 hours after birth and paired haematocrit differences between 0–4 and 4–24 hours.MethodsHaematocrits were obtained when clinically indicated and collected from arterial, venous and capillary sources. Haematocrits obtained after packed red blood cell transfusions were excluded. We summarised the first available haematocrit between 0 and 4 hours by GA strata. We used mixed-effects linear regression to describe the associations between haematocrit and predictor variables including GA, male sex and hours after an infant’s birth. We also compared paired haematocrits at 0–4 and 4–24 hours after birth.ResultsThe median GA of the 467 included infants was 33.3 weeks, birth weight was 1910 g and DCC duration was 60 s. The mean (95% CI) first haematocrit at 0–4 hours was 46.6 (45.0% to 48.1%), 51.2 (49.6% to 52.8%), 50.6 (49.1% to 52.1%), 54.3 (52.8% to 55.8%) and 55.6 (54.6% to 56.6%) for infants 23–29, 30–31, 32, 33 and 34 weeks’ GA strata, respectively. The subanalysis of 174 infants with paired haematocrits at 0–4 and 4–24 hours showed that for each additional hour after birth, the mean (95% CI) haematocrit increased by 0.2 (0.1% to 0.3%), 0.2 (0.1% to 0.4%) and 0.1 (0.0% to 0.2%) for infants in 23–29, 30–31 and 32 weeks’ GA strata, respectively. The subanalysis showed no change between the paired haematocrits in the 33 and 34 weeks’ GA strata.ConclusionsOur study describes haematocrit in preterm infants who received ≥60 s DCC as standard of care. Haematocrit during the first 0–4 hours in our study is higher than the previously described reference ranges prior to DCC becoming routine clinical practice. The paired second haematocrit at 4–24 hours is higher than haematocrit at 0–4 hours.

Thyroid-stimulating hormone reference ranges for moderate-to-late preterm infants

2020 ◽  
Author(s):  
Dinushan C. Kaluarachchi ◽  
Victoria M. Nicksic ◽  
David B. Allen ◽  
Jens C. Eickhoff ◽  
Sandra J. Dawe ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Thyroid Stimulating Hormone ◽  
Late Preterm ◽  
Reference Ranges ◽  
Late Preterm Infants ◽  
Stimulating Hormone

scholarly journals Correlation between Perfusion Index and Left Ventricular Output in Healthy Late Preterm Infants

2021 ◽  
Author(s):  
Ayça Aytekin ◽  
Nilay Hakan ◽  
Özkan İlhan ◽  
Mustafa Aydin ◽  
Haşim Olgun
Keyword(s):  
Preterm Infants ◽  
Left Ventricular ◽  
Perfusion Index ◽  
Late Preterm ◽  
Microvascular Blood Flow ◽  
Systemic Hemodynamic ◽  
Late Preterm Infants ◽  
Preterm Babies ◽  
Left Ventricular Output ◽  
The Mean

Aim The perfusion index (PI) is a noninvasive marker derived from photoelectric plethysmographic signals in pulse oximetry in the evaluation of peripheral perfusion. This study was aimed to determine the correlation between PI and left ventricular output (LVO) in healthy late preterm infants at 48th hour of life. Methods With new generation pulse oximeter (MASIMO Rad 7 Oximeter) pre- and post-ductal PI values were recorded from healthy late preterm babies at the 48th hour of life. PI was determined simultaneously with LVO as measured by transthoracic echocardiography. Results A total of 50 late preterm babies were included in the study. The mean gestational age of the cases was 35.4 ± 0.7 weeks and the birth weight was 2,586 ± 362 g. Mean pre- and post-ductal PI values at the postnatal 48th hour of babies' life were found to be 2.0 ± 0.9 and 1.7 ± 1.1. The mean LVO value was 438 ± 124, LVO/kg 175 ± 50. When the LVO value was normalized according to the babies' body weight, there was no statistically significant correlation between the pre- and post-ductal PI and the LVO/kg value (r <0.2, p >0.05 in both comparisons). Conclusion There was no correlation between pre- and post-ductal PI and LVO values in healthy late preterm infants. This may be due to the failure of the LVO, a systemic hemodynamic parameter, to accurately reflect microvascular blood flow due to incomplete maturation of the sympathetic nervous system involved in the regulation of peripheral tissue perfusion in preterm babies. Key Points

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