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

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

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Umbilical cord milking versus delayed cord clamping in term and late-preterm infants: a systematic review and meta-analysis

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2021.1884676 ◽

2021 ◽

pp. 1-11

Author(s):

Amrit Jeevan ◽

Anitha Ananthan ◽

Manjari Bhuwan ◽

Haribalakrishna Balasubramanian ◽

Shripada Rao ◽

...

Keyword(s):

Systematic Review ◽

Preterm Infants ◽

Umbilical Cord ◽

Meta Analysis ◽

Late Preterm ◽

Delayed Cord Clamping ◽

Late Preterm Infants ◽

Cord Clamping ◽

Umbilical Cord Milking

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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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Milking of the Umbilical Cord in Term and Late Preterm Infants

BioMed Research International ◽

10.1155/2019/9185059 ◽

2019 ◽

Vol 2019 ◽

pp. 1-9 ◽

Cited By ~ 2

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.

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Short-Term Outcomes following Standardized Admission of Late Preterm Infants to Family-Centered Care

American Journal of Perinatology ◽

10.1055/s-0039-1694981 ◽

2019 ◽

Author(s):

Jonathan Reiss ◽

Pavan S. Upadhyayula ◽

Hyeri You ◽

Ronghui Xu ◽

Lisa M. Stellwagen

Keyword(s):

Preterm Infants ◽

Neonatal Intensive Care ◽

Transitions Of Care ◽

Late Preterm ◽

Family Centered Care ◽

Short Term ◽

Late Preterm Infants ◽

Car Seat ◽

Centered Care ◽

Family Centered

Abstract Objective The study compares the short-term outcomes of late preterm infants (LPI) at an academic center in San Diego, California after a change in protocol that eliminated a previously mandatory 12-hour neonatal intensive care unit (NICU) observation period after birth. Study Design This is a retrospective observational study examining all LPI born with gestational age 35 to 366/7 weeks between October 1, 2016 and October 31, 2017. A total of 189 infants were included in the review. Short-term outcomes were analyzed before and after the protocol change. Results Transfers to the NICU from family-centered care (FCC) were considerably higher (23.2%) following the protocol change, compared to before (8.2%). More infants were transferred to the NICU for failed car seat tests postprotocol compared to preprotocol. Length of stay before the protocol change was 5.13 days compared to 4.80 days after. Conclusion LPI are vulnerable to morbidities after delivery and through discharge. We found an increase in failed car seat tests in LPI cared for in FCC after elimination of a mandatory NICU observation after birth. The transitions of care from delivery to discharge are key checkpoints in minimizing complications.

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