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.

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.

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

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 Neonatal outcomes in preterm multiples receiving delayed cord clamping

2019 ◽  
Vol 104 (6) ◽  
pp. F575-F581 ◽  
Author(s):  
Priya Jegatheesan ◽  
Esther Belogolovsky ◽  
Matthew Nudelman ◽  
Dongli Song ◽  
Balaji Govindaswami
Keyword(s):  
Birth Weight ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Neonatal Outcomes ◽  
Delayed Cord Clamping ◽  
Major Morbidity ◽  
Cord Clamping ◽  
Signed Rank ◽  
Clinically Significant ◽  
Delivery Type

ObjectiveTo compare neonatal outcomes in singletons versus multiples, first-born versus second-born multiples and monochorionic versus dichorionic/trichorionic multiples <33 weeks’ gestational age (GA) who received delayed cord clamping (DCC).DesignRetrospective, observational study of 529 preterm infants receiving ≥30 s DCC. Generalised estimating equations and mixed effects models were used to compare outcomes in singletons versus multiples and monochorionic versus dichorionic/trichorionic multiples. Wilcoxon signed-rank and McNemar tests were used to compare first-born versus second-born multiples.SettingLevel III neonatal intensive care unit, California, USA.Patients433 singletons and 96 multiples <33 weeks’ GA, born January 2008–December 2017, who received DCC.Results86% of multiples and 83% of singletons received DCC. Multiples had higher GA (31.0 weeks vs 30.6 weeks), more caesarean sections (91% vs 54%), fewer males (48% vs 62%) and higher 12–24 hour haematocrits (54.3 vs 50.5) than singletons. Haematocrit difference remained significant after adjusting for birth weight, delivery type and sex. Compared with first-born multiples, second-born multiples were smaller (1550 g vs 1438 g) and had lower survival without major morbidity (91% vs 77%). Survival without major morbidity was not significant after adjusting for birth weight. Compared with dichorionic/trichorionic multiples, monochorionic multiples had slightly lower admission temperatures (37.0°C vs 36.8°C), although this difference was not clinically significant. There were no other differences in delivery room, respiratory, haematological or neonatal outcomes between singletons and multiples or between multiples’ subgroups.ConclusionsNeonatal outcomes in preterm infants receiving DCC were comparable between singletons and multiples, first and second order multiples and monochorionic and dichorionic/trichorionic multiples.

Delayed cord clamping in infants born less than 35 weeks: A retrospective study

2020 ◽  
pp. 1-5
Author(s):  
N. Singh ◽  
D. Brammer
Keyword(s):  
Retrospective Study ◽  
Preterm Infants ◽  
Neonatal Intensive Care ◽  
Primary Outcome ◽  
Practice Variation ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
The Difference

BACKGROUND: Evidence supports delayed cord clamping (DCC) in preterm infants. However, practice variation exists, and many preterm infants do not receive DCC despite multiple benefits and lack of harm. We aim to 1) study the rate of DCC in preterm infants, 2) compare the difference between infants who received DCC and those who did not receive DCC and 3) investigate the reasons for not performing DCC. METHODS: We conducted this retrospective study to evaluate DCC practice at our institution since its implementation in September 2015. We collected and analyzed the data on DCC of 30–45 sec duration in inborn infants <  35 weeks gestation admitted to the neonatal intensive care unit from June 2016- June 2019. The primary outcome was the rate of delayed cord clamping. RESULTS: Of the 447 infants, 275 (62%) received DCC. The rate of DCC was 36% , 54% , and 66% in infants <  27 weeks, 27–29 weeks and >  30 weeks gestation, respectively (p = 0.001). Infants not receiving DCC were smaller, of lower gestational age, and more likely to be delivered via cesarean section than those who received DCC (p <  0.0001). Infants not receiving DCC had a higher rate of receiving PPV or intubation and a 1minute Apgar score of <  5 compared to those receiving DCC. We could not establish the reason for not performing DCC because of inadequate documentation in the medical records. CONCLUSIONS: The rate of DCC is low in clinical practice, in particular among extremely preterm infants.

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