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

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.

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

Pediatric Research ◽

10.1038/s41390-021-01805-y ◽

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.

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Efficiency and safety of phenylephrine and tropicamide used in premature retinopathy: a prospective observational study

BMC Pediatrics ◽

10.1186/s12887-019-1757-3 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Atilla Alpay ◽

Sılay Canturk Ugurbas ◽

Cumhur Aydemir

Keyword(s):

Heart Rate ◽

Side Effects ◽

Observational Study ◽

Respiratory Distress Syndrome ◽

Oxygen Saturation ◽

Prospective Observational Study ◽

Distress Syndrome ◽

Pupillary Diameter ◽

The Mean ◽

Rop Screening

Abstract Background To determine effects and side effects of topical application of phenylephrine 2.5% and tropicamide 0.5% combination in preterm infants. Methods In this prospective observational study, 60 infants undergoing retinopathy of prematurity (ROP) screening were prospectively observed. Pupillary diameter, blood pressure, heart rate, and oxygen saturation were monitored before and after up to 24 h during ROP screening examinations. Results The mean pupillary diameter 1 h after the instillation of drops was 5.58 ± 0.75 mm for both eyes. The mean systolic and diastolic pressure and oxygen saturation of infants did not change statistically until the end of the study. The average heart rate decreased by a mean of 4.96 beats/minute from the baseline following eye drops instillation. General condition deterioration, fall in oxygen saturation and bradycardia were observed in 4 infants that already had respiratory distress syndrome. Conclusion The phenylephrine 2.5% plus tropicamide 0.5% drop is effective and safe as mydriatic combination for retinopathy of prematurity screening. In infants with an additional systemic disease such as respiratory distress syndrome, the side effects of mydriatic drops may be more common. Such babies should be kept under close observation. Trial registration The trial was retrospectively registered on 28 February 2018. The ClinicalTrials.gov Identifier is NCT03448640.

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Heart rate variability as a predictor of hypotension following spinal for elective caesarean section: a prospective observational study

Anaesthesia ◽

10.1111/anae.13813 ◽

2017 ◽

Vol 72 (5) ◽

pp. 603-608 ◽

Cited By ~ 11

Author(s):

D. G. Bishop ◽

C. Cairns ◽

M. Grobbelaar ◽

R. N. Rodseth

Keyword(s):

Heart Rate ◽

Heart Rate Variability ◽

Caesarean Section ◽

Observational Study ◽

Prospective Observational Study ◽

Elective Caesarean Section

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Changes in heart rate from 5 s to 5 min after birth in vaginally delivered term newborns with delayed cord clamping

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-320179 ◽

2020 ◽

pp. fetalneonatal-2020-320179

Author(s):

Peder Aleksander Bjorland ◽

Hege Langli Ersdal ◽

Joar Eilevstjønn ◽

Knut Øymar ◽

Peter G Davis ◽

...

Keyword(s):

Heart Rate ◽

Prospective Observational Study ◽

Medical Intervention ◽

University Hospital ◽

Single Centre ◽

Delayed Cord Clamping ◽

Cord Clamping ◽

Normal Heart Rate ◽

Dry Electrode ◽

Term Newborns

ObjectiveTo determine heart rate centiles during the first 5 min after birth in healthy term newborns delivered vaginally with delayed cord clamping.DesignSingle-centre prospective observational study.SettingStavanger University Hospital, Norway, March–August 2019.PatientsTerm newborns delivered vaginally were eligible for inclusion. Newborns delivered by vacuum or forceps or who received any medical intervention were excluded.InterventionsA novel dry electrode electrocardiography monitor (NeoBeat) was applied to the newborn’s chest immediately after birth. The newborns were placed on their mother’s chest or abdomen, dried and stimulated, and cord clamping was delayed for at least 1 min.Main outcome measuresHeart rate was recorded at 1 s intervals, and the 3rd, 10th, 25th, 50th, 75th, 90th and 97th centiles were calculated from 5 s to 5 min after birth.Results898 newborns with a mean (SD) birth weight 3594 (478) g and gestational age 40 (1) weeks were included. The heart rate increased rapidly from median (IQR) 122 (98–146) to 168 (146–185) beats per minute (bpm) during the first 30 s after birth, peaking at 175 (157–189) bpm at 61 s after birth, and thereafter slowly decreasing. The third centile reached 100 bpm at 34 s, suggesting that heart rates <100 bpm during the first minutes after birth are uncommon in healthy newborns after delayed cord clamping.ConclusionThis report presents normal heart rate centiles from 5 s to 5 min after birth in healthy term newborns delivered vaginally with delayed cord clamping.

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Effect of early versus delayed cord clamping in neonate on heart rate, breathing and oxygen saturation during first 10 minutes of birth - randomized clinical trial

Maternal Health Neonatology and Perinatology ◽

10.1186/s40748-019-0103-y ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 7

Author(s):

Ashish KC ◽

Nalini Singhal ◽

Jageshwor Gautam ◽

Nisha Rana ◽

Ola Andersson

Keyword(s):

Clinical Trial ◽

Heart Rate ◽

Oxygen Saturation ◽

Randomized Clinical Trial ◽

Delayed Cord Clamping ◽

Cord Clamping

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

BMJ Paediatrics Open ◽

10.1136/bmjpo-2019-000531 ◽

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.

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