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

2019 ◽  
Author(s):  
Michael Johnston
Keyword(s):  
Preterm Infants ◽  
Cerebral Autoregulation ◽  
Intraventricular Hemorrhage ◽  
Delayed Cord Clamping ◽  
Cord Clamping ◽  
Dynamic Cerebral Autoregulation

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

2019 ◽  
Vol 127 (1) ◽  
pp. 103-110 ◽  
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.

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

Children ◽  
2019 ◽  
Vol 6 (4) ◽  
pp. 59 ◽  
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.

scholarly journals Effects of Delayed Cord Clamping on Intraventricular Hemorrhage in Preterm Infants

2017 ◽  
Vol 27 (5) ◽  
Author(s):  
Mobina Varij Kazemi ◽  
Zahra Akbarianrad ◽  
Yadolla Zahedpasha ◽  
Raheleh Mehraein ◽  
Mohsen Haghshenas Mojaveri
Keyword(s):  
Preterm Infants ◽  
Intraventricular Hemorrhage ◽  
Delayed Cord Clamping ◽  
Cord Clamping

Effect of Delayed Cord Clamping Reduced Anemic Outcome in Preterm Neonate

2021 ◽  
Vol 104 (5) ◽  
pp. 695-700
Keyword(s):  
Intraventricular Hemorrhage ◽  
Preterm Neonate ◽  
Controlled Trial ◽  
Preterm Neonates ◽  
Maternal Outcomes ◽  
Delayed Cord Clamping ◽  
Randomized Controlled ◽  
Cord Clamping ◽  
Significant Difference ◽  
The Mean

Objective: To compare the effects of immediate versus delayed cord clamping on neonatal outcomes in preterm neonates of gestational age of 32 to 36⁺⁶ weeks, and maternal outcomes. Materials and Methods: A randomized controlled trial was conducted in the Obstetrics and Gynecology Department at Bhumibol Adulyadej Hospital, in Bangkok, Thailand. The study compared the effects of immediate to delayed cord clamping at 60 seconds among preterm neonates born between 32 weeks, 0 day and 36 weeks, 6 days of gestation between August and October 2018. Results: The mean age of the participants was 26 years old, and half of the cases were nulliparous. One hundred ten women were randomly separated into two equal groups (n=55). Delayed cord clamping at 60 seconds increased hematocrit levels (Hct) in both two (p=0.004) and 48 (p<0.001) hours after delivery compared to the immediate cord clamping group. There were no differences in exposing the neonate to hypothermia, hypoxemia, Apgar score at 1-minute, polycythemia, intraventricular hemorrhage, hyperbilirubinemia, length of stay in hospital, and affecting the process of resuscitation. There were no statistical differences between the two groups in maternal outcomes such as retained placenta and postpartum hemorrhage. Conclusion: Delayed cord clamping at 60 seconds increased Hct in the newborn at two to 48 hours after birth. There was no significant difference in adverse maternal and neonatal complications within both groups. Keywords: Delayed cord clamping, Hematocrit, Preterm

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

2017 ◽  
Vol 103 (3) ◽  
pp. F257-F263 ◽  
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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