The Assisted Breathing before Cord Clamping (ABC) Study Protocol

Major physiologic changes occur during the transition after birth. For preterm infants, current understanding favours allowing the initial changes to occur prior to cord clamping. Amongst other improved outcomes, systematic reviews have indicated a significant reduction in neonatal blood transfusions following delayed cord clamping. This may be due to a placental transfusion, facilitated by the onset of respiration. If breathing is compromised, placental transfusion may be reduced, resulting in a greater red cell transfusion rate. We designed a randomised trial to investigate whether assisting respiration in this high-risk group of babies would decrease blood transfusion and improve outcomes. The Assisted Breathing before Cord Clamping (ABC) study is a single-centre randomised controlled trial. Preterm infants < 31 weeks that have not established regular breathing before 15 s are randomised to a standard or intervention group. The intervention is intermittent positive pressure ventilation via T piece for 30 s, whilst standard management consists of 30 s of positioning and gentle stimulation. The cord is clamped at 50 s in both groups. The primary outcome is the proportion of infants in each group receiving blood transfusion during the neonatal admission. Secondary outcomes include requirement for resuscitation, the assessment of circulatory status and neonatal outcomes.

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Interobserver agreement and image quality of functional cardiac ultrasound measures used in a randomised trial of delayed cord clamping in preterm infants

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2016-312006 ◽

2017 ◽

Vol 103 (3) ◽

pp. F257-F263 ◽

Cited By ~ 6

Author(s):

Himanshu Popat ◽

Kristy P Robledo ◽

Lucille Sebastian ◽

Nicholas Evans ◽

Andrew Gill ◽

...

Keyword(s):

Image Quality ◽

Preterm Infants ◽

Interobserver Agreement ◽

Ductus Arteriosus ◽

Randomised Trial ◽

Vena Cava ◽

Mean Difference ◽

Cardiac Ultrasound ◽

Delayed Cord Clamping ◽

Cord Clamping

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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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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ASSOCIATIONS OF MEASURES OF SYSTEMIC BLOOD FLOW USED IN A RANDOMISED TRIAL OF DELAYED CORD CLAMPING IN PRETERM INFANTS

Journal of Paediatrics and Child Health ◽

10.1111/jpc.14410_116 ◽

2019 ◽

Vol 55 (S1) ◽

pp. 94-94

Keyword(s):

Blood Flow ◽

Preterm Infants ◽

Randomised Trial ◽

Delayed Cord Clamping ◽

Systemic Blood ◽

Systemic Blood Flow ◽

Cord Clamping

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Safety and Ergonomic Challenges of Ventilating a Premature Infant During Delayed Cord Clamping

Children ◽

10.3390/children6040059 ◽

2019 ◽

Vol 6 (4) ◽

pp. 59 ◽

Cited By ~ 2

Author(s):

Wannasiri Lapcharoensap ◽

Allison Cong ◽

Jules Sherman ◽

Doug Schwandt ◽

Susan Crowe ◽

...

Keyword(s):

Preterm Infants ◽

Airway Pressure ◽

Intraventricular Hemorrhage ◽

Positive Pressure Ventilation ◽

Positive Airway Pressure ◽

Professional Organizations ◽

Positive Pressure ◽

Delayed Cord Clamping ◽

Cord Clamping ◽

Simulation Based

Delayed cord clamping (DCC) is endorsed by multiple professional organizations for both term and preterm infants. In preterm infants, DCC has been shown to reduce intraventricular hemorrhage, lower incidence of necrotizing enterocolitis, and reduce the need for transfusions. Furthermore, in preterm animal models, ventilation during DCC leads to improved hemodynamics. While providing ventilation and continuous positive airway pressure (CPAP) during DCC may benefit infants, the logistics of performing such a maneuver can be complicated. In this simulation-based study, we sought to explore attitudes of providers along with the safety and ergonomic challenges involved with safely resuscitating a newborn infant while attached to the placenta. Multidisciplinary workshops were held simulating vaginal and Caesarean deliveries, during which providers started positive pressure ventilation and transitioned to holding CPAP on a preterm manikin. Review of videos identified 5 themes of concerns: sterility, equipment, mobility, space and workflow, and communication. In this study, simulation was a key methodology for safe identification of various safety and ergonomic issues related to implementation of ventilation during DCC. Centers interested in implementing DCC with ventilation are encouraged to form multidisciplinary work groups and utilize simulations prior to performing care on infants.

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