Delayed cord clamping saves lives of preterm infants

ObjectiveFunctional cardiac ultrasound measures are used clinically and in trials for assessing the haemodynamic status of newborn infants. Superior vena cava (SVC) flow and right ventricular output (RVO) are established measures of systemic blood flow on the first postnatal day. The objective was to assess image quality and interobserver agreement of these measures in preterm infants enrolled in a randomised trial of immediate versus delayed cord clamping.Design and settingImage quality and interobserver agreement for SVC flow, RVO and ductus arteriosus (DA) size were assessed on measurements taken at 3–6, 6–12 and 20–28 hours for the first 10 infants enrolled at each of four sites (total 40). Bland-Altman plots were constructed; mean difference (bias) and limits of agreement (LOA) were calculated. Potential sources of variation were explored.ResultsQuality was judged satisfactory for >97% of images. The mean difference and LOA between the observers were 5.4 mL/kg/min and −49.0 to 59.8 mL/kg/min for SVC flow, −26.6 mL/kg/min and −131.4 to 78.2 mL/kg/min for RVO, and 0 mm and −0.8 to 0.8 mm for DA diameter, respectively. The principal source of measurement error for SVC flow was diameter, and for RVO, diameter and velocity time integral. The difference between observers for both SVC and RVO was significantly associated with site.ConclusionInterobserver variability for SVC flow is consistent with that previously reported, but higher for RVO. The findings should be incorporated into clinical practice, training, accreditation and trial design.

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Effect of delayed cord clamping on stem cell transfusion and hematological parameters in preterm infants with placental insufficiency: a pilot randomized trial

European Journal of Pediatrics ◽

10.1007/s00431-020-03730-4 ◽

2020 ◽

Vol 180 (1) ◽

pp. 157-166

Author(s):

Mohammed Yunis ◽

Islam Nour ◽

Ahmed Gibreel ◽

Mohamad Darwish ◽

Mohamed Sarhan ◽

...

Keyword(s):

Stem Cell ◽

Randomized Trial ◽

Preterm Infants ◽

Hematological Parameters ◽

Placental Insufficiency ◽

Delayed Cord Clamping ◽

Cord Clamping

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The “DUC” trial: a pilot randomized controlled trial of immediate versus delayed cord clamping in preterm infants born between 24 and 32 weeks gestation

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2019.1702959 ◽

2019 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Kelly S. Chu ◽

Prakesh S. Shah ◽

Wendy L. Whittle ◽

Rory Windrim ◽

Kellie E. Murphy

Keyword(s):

Randomized Controlled Trial ◽

Preterm Infants ◽

Controlled Trial ◽

Delayed Cord Clamping ◽

Randomized Controlled ◽

Cord Clamping ◽

Pilot Randomized Controlled Trial

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Delayed cord clamping is associated with improved dynamic cerebral autoregulation and decreased incidence of intraventricular hemorrhage in preterm infants

Journal of Applied Physiology ◽

10.1152/japplphysiol.00049.2019 ◽

2019 ◽

Vol 127 (1) ◽

pp. 103-110 ◽

Cited By ~ 3

Author(s):

Zachary A. Vesoulis ◽

Steve M. Liao ◽

Amit M. Mathur

Keyword(s):

Preterm Infants ◽

Cerebral Autoregulation ◽

Intraventricular Hemorrhage ◽

Risk Index ◽

Delivery Mode ◽

Delayed Cord Clamping ◽

Arterial Blood ◽

Cord Clamping ◽

Significant Difference ◽

Dynamic Cerebral Autoregulation

Delayed cord clamping (DCC) improves neurologic outcomes in preterm infants through a reduction in intraventricular hemorrhage (IVH) incidence. The mechanism behind this neuroprotective effect is not known. Infants born <28 wk gestation were recruited for longitudinal monitoring. All infants underwent 72 h of synchronized near-infrared spectroscopy (NIRS) and mean arterial blood pressure (MABP) recording within 24 h of birth. Infants with DCC were compared with control infants with immediate cord clamping (ICC), controlling for severity of illness [clinical risk index for babies (CRIB-II) score], chorioamnionitis, antenatal steroids, sedation, inotropes, and delivery mode. Autoregulatory dampening was calculated as the transfer function gain coefficient between the MABP and NIRS signals. Forty-five infants were included (DCC; n = 15, paired 2:1 with ICC controls n = 30). ICC and DCC groups were similar including gestational age (25.5 vs. 25.2 wk, P = 0.48), birth weight (852.3 vs. 816.6 g, P = 0.73), percent female (40 vs. 40%, P = 0.75), and dopamine usage (27 vs. 23%, P = 1.00). There was a significant difference in IVH incidence between the DCC and ICC groups (20 vs. 50%, P = 0.04). Mean MABP was not different (35.9 vs. 35.1 mmHg, P = 0.44). Compared with the DCC group, the ICC group had diminished autoregulatory dampening capacity (−12.96 vs. −15.06 dB, P = 0.01), which remained significant when controlling for confounders. Dampening capacity was, in turn, strongly associated with decreased risk of IVH (odds ratio = 0.14, P < 0.01). The results of this pilot study demonstrate that DCC is associated with improved dynamic cerebral autoregulatory function and may be the mechanism behind the decreased incidence of IVH. NEW & NOTEWORTHY The neuroprotective mechanism of delayed cord clamping in premature infants is unclear. Delayed cord clamping was associated with improved cerebral autoregulatory function and a marked decrease in intraventricular hemorrhage (IVH). Improved dynamic cerebral autoregulation may decrease arterial baroreceptor sensitivity, thereby reducing the risk of IVH.

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