Recent advances in perinatal neuroprotection

Perinatal brain injury is a major cause of neurological disability in both premature and term infants. In this review, we summarize the evidence behind some established neuroprotective practices such as administration of antenatal steroids, intrapartum magnesium for preterm delivery, and therapeutic hypothermia. In addition, we examine emerging practices such as delayed cord clamping, postnatal magnesium administration, recombinant erythropoietin, and non-steroidal anti-inflammatory agents and finally inform the reader about novel interventions, some of which are currently in trials, such as xenon, melatonin, topiramate, allopurinol, creatine, and autologous cord cell therapy.

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Perinatal neuroprotection update

F1000Research ◽

10.12688/f1000research.8546.1 ◽

2016 ◽

Vol 5 ◽

pp. 1939 ◽

Cited By ~ 4

Author(s):

Angie C. Jelin ◽

Kirsten Salmeen ◽

Dawn Gano ◽

Irina Burd ◽

Mari-Paule Thiet

Keyword(s):

Preterm Delivery ◽

Significant Risk ◽

Autism Spectrum ◽

Neurological Deficits ◽

Delayed Cord Clamping ◽

Neurological Outcomes ◽

Cord Clamping ◽

Cognitive Delay ◽

Neurological Risk

Antepartum, intrapartum, and neonatal events can result in a spectrum of long-term neurological sequelae, including cerebral palsy, cognitive delay, schizophrenia, and autism spectrum disorders [1]. Advances in obstetrical and neonatal care have led to survival at earlier gestational ages and consequently increasing numbers of periviable infants who are at significant risk for long-term neurological deficits. Therefore, efforts to decrease and prevent cerebral insults attempt not only to decrease preterm delivery but also to improve neurological outcomes in infants delivered preterm. We recently published a comprehensive review addressing the impacts of magnesium sulfate, therapeutic hypothermia, delayed cord clamping, infections, and prevention of preterm delivery on the modification of neurological risk [2]. In this review, we will briefly provide updates to the aforementioned topics as well as an expansion on avoidance of toxin and infections, specifically the Zika virus.

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Increment in Phototherapy After Adopting Delayed Cord Clamping Practice

Journal of Neonatology ◽

10.1177/09732179211060755 ◽

2021 ◽

pp. 097321792110607

Author(s):

Chinmay Chetan ◽

Nishant Banait ◽

Vikramaditya Athelli ◽

Bhvya Gupta ◽

Prince Pareek ◽

...

Keyword(s):

Tertiary Care ◽

World Health ◽

Care Hospital ◽

Delayed Cord Clamping ◽

Term Infants ◽

Cord Clamping ◽

Early Cord Clamping ◽

Baseline Characteristics ◽

Health Organization ◽

Larger Sample

Introduction: World Health Organization (WHO) in 2014 recommended delayed cord clamping (DCC) in all babies who cry immediately after birth. Despite many benefits, there are concerns of increased rate of phototherapy in babies receiving DCC. This study was done to determine the increment in the rate of phototherapy required in infants managed with DCC vs infants managed with early cord clamping (ECC). Methods: A retrospective observational study was conducted in a tertiary care hospital in Pune, India. All the infants born between January 2018 and July 2018, for whom ECC was done, were compared with infants who were born between January 2019 and July 2019, after DCC policy was adopted. All the infants with birth weight ≥2 kg and gestation ≥35 weeks, who were with their mother, were included. Baseline characteristics were compared for both the groups. American Academy of Pediatrics guidelines for treatment of neonatal jaundice were used to determine the need for phototherapy. Number of infants in both the groups who required phototherapy were compared. Results: The ECC group had 565 infants while DCC group had 731 infants. There was no difference in the baseline characteristics of the 2 groups. Jaundice requiring phototherapy was noted in 31% of infants in the ECC group, compared to 45% in infants in the DCC group (relative risk: 1.47 [1.27-1.71] [ P < .001]). Conclusion: In this study, DCC increased the need for phototherapy by 47% in late preterm and term infants. Randomized control trials with larger sample size are required to confirm this finding.

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

Journal of Perinatology ◽

10.1038/s41372-020-00825-6 ◽

2020 ◽

Cited By ~ 1

Author(s):

Kazumasa Fuwa ◽

Natsuko Tabata ◽

Ryo Ogawa ◽

Nobuhiko Nagano ◽

Noyuri Yamaji ◽

...

Keyword(s):

Systematic Review ◽

Umbilical Cord ◽

Meta Analysis ◽

Delayed Cord Clamping ◽

Term Infants ◽

Cord Clamping ◽

Umbilical Cord Milking

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Delayed Cord Clamping Prevalence Among US Hospitals

Current Developments in Nutrition ◽

10.1093/cdn/nzab046_090 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 793-793

Author(s):

Jasmine Nakayama ◽

Cria Perrine ◽

Heather Hamner ◽

Ellen Boundy

Keyword(s):

Cesarean Section ◽

Infant Nutrition ◽

Cesarean Section Rate ◽

Teaching Hospitals ◽

Delayed Cord Clamping ◽

Term Infants ◽

Non Profit ◽

Funding Sources ◽

Official Position ◽

Cord Clamping

Abstract Objectives Delayed cord clamping (DCC) allows transfusion of placental blood to a newborn after birth and is recommended by the American College of Obstetricians and Gynecologists. DCC can increase hemoglobin levels and iron stores in term infants, preventing or delaying iron deficiency in young children. This study describes the prevalence of DCC in US hospitals overall and by facility characteristics. Methods The 2018 Maternity Practices in Infant Nutrition and Care survey is a census of US hospitals providing maternity care and assesses hospitals' practices, including “How many healthy newborns at your hospital have their umbilical cord clamped more than one minute after birth?” We estimated the prevalence of hospitals reporting that most (i.e., 80%+) healthy newborns received DCC overall and by facility characteristics (i.e., Baby-Friendly designation, teaching status, type, annual live births, and annual Cesarean section rate). Results 2,042 hospitals were included, and 50% reported that most healthy newborns received DCC. DCC prevalence was 49% at non-Baby Friendly hospitals and 53% at Baby-Friendly hospitals. The prevalence of healthy newborns receiving DCC was 50% at teaching hospitals and 51% at non-teaching hospitals. DCC prevalence ranged from 43% among private hospitals to 52% among non-profit hospitals, from 46% among hospitals with 2,000–4,999 births births/year to 53% among hospitals with <500 births/year, and from 37% among hospitals with annual Cesarean section rates ≥35% to 61% among hospitals with annual Cesarean section rates <25%. Conclusions This study provides a national baseline for DCC among US hospitals. Only half of hospitals report DCC for most healthy newborns with notable variation by annual Cesarean section rate. There are opportunities to increase DCC prevalence to meet recommendations through continued training of clinicians, modification of obstetric protocols, and greater awareness among patients. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Funding Sources No funding was provided for this study.

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Is Erythropoietin Combining with Therapeutic Hypothermia an Efficient and Safe Therapy in Neonatal Hypoxic Ischemic Encephalopathy: A Prospective and Randomized Clinical Trial

10.21203/rs.3.rs-26962/v1 ◽

2020 ◽

Author(s):

Liang-yan Zou ◽

Bing-xue Huang ◽

Peng Zhang ◽

Guo-qiang Cheng ◽

Chun-mei Lu ◽

...

Keyword(s):

Brain Injury ◽

Adverse Events ◽

Therapeutic Hypothermia ◽

Brain Mri ◽

Adverse Outcomes ◽

Hypoxic Ischemic Encephalopathy ◽

Control Group ◽

Term Infants ◽

Basal Nuclei ◽

Ischemic Encephalopathy

Abstract BackgroundTo evaluate the efficacy and safety of erythropoietin (Epo) combined with therapeutic hypothermia (TH) in neonatal hypoxic-ischemic encephalopathy (HIE).MethodsA total of 78 term infants with HIE were assigned randomly to receive Epo (n = 40) or placebo (n = 38). All infants received TH. Blood samples before TH, after TH and after Epo/placebo were collected for measuring TH associated adverse events, Epo associated factors and potential neural biomarkers. Basal ganglia/ watershed (BG/W) scoring system was used to assess brain injury in MRI. Neurodevelopmental evaluations were performed at 18 months by using BayleyScales of Infant Development II (Bayley II).ResultsEpo-treated group tend to have lower serum creatine kinase (CK) concentration (114 vs 202, P = .04) and higher serum K+, Mg2+ concentration (5.0 vs 4.5, P = .03; 1.0 vs 0.9, P = .02) than control group after intervention. Brain MRI was performed in 65 (83%) neonatal. Totally brain injury score was in even distribution between two groups (median, 0 vs 0, P = .61), but injury region in cortex plus basal nuclei comparing with in basal nuclei solely was less common in the Epo than in the control group (21% vs 31%, P = .046). Only forty patients (40/78, 51%) succeeded in achieving 18-month follow up data. The totally adverse outcomes were trend to decline in the Epo group (35% vs 60%, P = .21). No adverse events were ascribed to Epo treatment.ConclusionsThe combination of Epo and TH is proved to be feasible, safe and potential effective.Trial registration: ChiCTR-TRC-14004532, date of registration: April 18th, 2014.

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Assessment of effectiveness of delayed cord clamping and umbilical cord milking in early term and preterm infants

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20183840 ◽

2018 ◽

Vol 5 (6) ◽

pp. 2071

Author(s):

Mahendra K. Jain ◽

Nidhi Bhedru ◽

Anubhuti Jain

Keyword(s):

Umbilical Cord ◽

Randomized Study ◽

Delayed Cord Clamping ◽

Term Infants ◽

Early Term ◽

Cord Clamping ◽

Significant Difference ◽

Insignificant Difference ◽

Nicu Admission ◽

Umbilical Cord Milking

Background: Early cord clamping and cutting of the umbilical cord is widely practiced as part of the management of labor; it could deprive the neonate of about a quarter of its blood volume and iron. This thesis is aimed at comparing effects of delayed cord clamping versus umbilical cord milking at birth in preterm and early term infants.Methods: This single centered randomized study was conducted in Department of Pediatrics and data collection was done on the basis of the preterm and early term infants delivered by vaginal or cesarean delivery in Department of Gynecology, Geetanjali Medical College and Hospital, Udaipur during period of January 2016 to January 2017. Total of 120 infants were included in the study.Results: Statistically it has been analyzed that in both pre-term and early term infants who underwent DDC and UCM, there was insignificant difference in level of hemoglobin (Hb), haematocrit (HCT), blood sugar, bilirubin level (TSB) and temperature of body. On the other hand, significant difference was observed in weight and cord pH of neonates of both groups. There is also insignificant difference in terms of NICU admission for RDS, sepsis, phototherapy, need of oxygen, saline boluses, PRBC transfusion, polycythemia.Conclusions: Thus, overall it was observed that there is insignificant difference in delayed cord clamping and umbilical cord milking group. Thus, both are found to be equally effective in improving hematologic parameters.

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Pengaruh Delayed Cord Clamping terhadap Kadar Hemoglobin (HB) dan Hematokrit (HT) pada Bayi

Jurnal Sehat Mandiri ◽

10.33761/jsm.v15i1.199 ◽

2020 ◽

Vol 15 (1) ◽

pp. 112-121

Author(s):

Bunga Tiara Carolin ◽

Suprihatin . ◽

Ami Damayanti

Keyword(s):

T Test ◽

Deficiency Anemia ◽

Control Group ◽

Delayed Cord Clamping ◽

Term Infants ◽

Control Group Design ◽

Cord Clamping ◽

Group Data ◽

The Mean ◽

Experimental Group

The main serious problem in Indonesia is anemia, this is a major nutritional problem in children in Indonesia. The incidence of iron deficiency anemia in term infants 0-6 months is 40.8%. One of the efforts to deal with anemia in infants and toddlers is by delaying the clamping and cutting of the center because the newborn is still getting a blood transfusion from the placenta around 100 ml. The Objective to determine the effect of delaying cord clamping and cutting on hemoglobin (Hb) and hematocrit (Ht) levels in infants at Utama Anny Rahardjo Clinic. This research is an experimental research with posttest only control group design. The population in this study were all babies born from May - July 2019. Sampling in the study with purposive sampling so that 15 respondents were obtained as the control group and 15 respondents as the experimental group. Data analysis uses independent t-test. The mean Hb and Ht levels of the control group were 15.033 gr/dl and 46.25% and the mean in the experimental group was 19.332 gr/dl for Hb and Ht 59.11%. The results of the analysis by independent t-test obtained a significance value 0,000. The Conclusion there are differences in Hb and Ht levels in infants with immediate and delayed cord cutting and clamping.

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