cord clamping newborn

• Safety of different cord clamping strategies in the early postnatal period

  Early Hum Dev. 2024 Jul 10;195:106075. doi: 10.1016/j.earlhumdev.2024.106075. Online ahead of print.ABSTRACTBACKGROUND: This study aimed to evaluate the effect of ICC (cord clamping within the first 15 s), DCC (delayed cord clamping at 60 s), and cut-UCM (cut-umbilical cord milking, cord clamping within the first 15 s) groups on oxygen saturation (SpO2), heart rate (HR), and perfusion index (PI) up to 10 min after birth in newborn infants.METHODS: We conducted this randomized clinical trial in the delivery unit of a University Hospital with 189 infants born between 35 and 42 weeks of gestation. Participants were randomly assigned to one of three groups: ICC, DCC, and cut-UCM. The primary outcomes measured were SpO2, HR, and PI at the 1st, 3rd, 5th, and 10th minutes after birth. We utilized ANOVA and Bayesian calculations in this study.RESULTS: There was no difference between the ICC, DCC, and cut-UCM groups in SpO2, HR, and PI values at the 1st, 3rd, 5th, and 10th minutes of life, which did not significantly alter between the three groups in one-way ANOVA. Bayesian repeated-measure ANOVA calculations showed that SpO2 and heart rate results at the 1st, 3rd, 5th, and 10th minutes did not differ between ICC, DCC, and cut-UCM techniques with strong evidence. At the 3rd minute, PI was slightly higher in the DCC and cut-UCM groups compared to the ICC group, with anecdotal evidence. We found no difference between DCC and cut-UCM regarding the 3rd-minute PI, with moderate evidence.CONCLUSION: Umbilical clamping procedures (ICC, DCC, and cut-UCM) did not affect SpO2 and HR in the first ten minutes of life, but 3rd-minute PI values were slightly higher in DCC and cut-UCM compared with ICC among late preterm and term neonates.PMID:39002384 | DOI:10.1016/j.earlhumdev.2024.106075…
  13 July 2024 12:00 – Akan Yaman

• Bacterial species in cord blood and their significance in the context of clinical use

  Transfus Apher Sci. 2024 Jun 29;63(4):103961. doi: 10.1016/j.transci.2024.103961. Online ahead of print.ABSTRACTApproximately 90 % of infants born before 28 full weeks(extremely-preterm-infants) receive erythrocyte transfusions in early life. Umbilical cord blood(UCB) has been investigated as an alternative source for erythrocyte transfusions to preterm neonates. This retrospective study aimed to compile/evaluate spectrum of bacteria groups/species intermittently detected in processed UCB at National-Swedish-Cord blood bank, (NS-CBB) during the years 2008-2020. Consecutive data from the years 2008-2020 were investigated. UCB from healthy newborns born after 37 full weeks of gestation was collected following clamping of cord (1 min) through cannulation of umbilical vein(vaginal-and C-section-deliveries). In total, 5194 cord blood units (UCBUs) that met NS-CBB-guidelines for total nucleated-cell-content(TNC) were manufactured from 8875 collections. Of 5194 UCBUs,77,6 % were from vaginal-and 22,4 % from C-section deliveries.Samples(10 mL) were collected from surplus eryhtrocyte fraction post-processing(n = 5194), transferred into BACT/ALERT® aerobic/anaerobic culture flasks and monitored 10 days using BACT/ALERT®-3D-Microbial-Detection-Systems. Positive samples were subcultured and typed for bacterial groups and/or species. Out of 5194 processed sampled UCB units,186 (3,6 %) were discarded due to positive sterility tests, 92 % were detected in samples from vaginal-deliveries and 8 % from C-section-deliveries. In all,16 different groups of bacteria and 27 species were identified. Common bacterial/groups and species were anaerobe gram-negative rods(n = 28),coagulase-negative-staphylococci(n = 21),gram-positive rods(n = 21),anaerobe-gram-positive cocci(n = 20) and viridans-streptococci(n = 13). Extracted from these results,in positive samples(n = 13) from C-section deliveries, bacteria were found:viridans-streptococci(n = 7),Aerococcus-urinae(n = 1), Staphylococcus lugdunensis(n = 1),other coagulase-negative staphylococci(n = 1) or a mix of aerobic/anaerobic bacteria(n = 3). Our results are in alignment with previously published contamination rates in processed UCBUs. Still, results point towards importance of strict microbial monitoring when manufacturing UCBUs to achieve patient-safe- products for stem-cell transplantation/transfusion.PMID:38981148 | DOI:10.1016/j.transci.2024.103961…
  9 July 2024 12:00 – Helena Barreto Henriksson

• Cord Obstruction and Delayed Cord Clamping Do Not Affect Gut Function in Neonatal Piglets

  Neonatology. 2024 Jun 28:1-10. doi: 10.1159/000539527. Online ahead of print.ABSTRACTINTRODUCTION: Birth-related obstruction of umbilical blood flow may induce hypoxic insults that affect postnatal organ adaptation. Using newborn cesarean-delivered pigs, we hypothesized that cord obstruction during delivery negatively affects physiological transition and gut maturation. Further, we investigated if delayed cord clamping (DCC) improves gut outcomes, including sensitivity to formula-induced necrotizing enterocolitis (NEC)-like lesions.METHODS: In experiment 1, preterm (n = 24) and near-term (n = 29) piglets were subjected to umbilical cord obstruction (UCO, 5-7 min in utero), with corresponding pigs delivered without obstruction (CON, n = 17-22). Experiment 2 assessed preterm pigs subjected to delayed cord clamping (n = 30, 60 s) or immediate cord transection with umbilical cord milking (UCM, n = 34). Postnatal vital parameters were recorded, together with a series of gut parameters after 3 days of formula feeding.RESULTS: UCO induced respiratory-metabolic acidosis in near-term pigs at birth (pH 7.16 vs. 7.32, pCO2 12.5 vs. 9.2 kPa, lactate 5.2 vs. 2.5 mmol/L, p < 0.05). In preterm pigs, UCO increased failure of resuscitation and mortality shortly after birth (88 vs. 47%, p < 0.05). UCO did not affect gut permeability, transit time, macromolecule absorption, six digestive enzymes, or sensitivity to NEC-like lesions. In experiment 2, DCC improved neonatal hemodynamics (pH 7.28 vs. 7.20, pCO2 8.9 vs. 9.9 at 2 h, p < 0.05), with no effects on gut parameters.CONCLUSION: UCO and DCC affect neonatal transition and hemodynamics, but not neonatal gut adaptation or sensitivity to NEC-like lesions. Our findings suggest that the immature newborn gut is highly resilient to transient birth-related changes in cord blood flow.PMID:38952138 | DOI:10.1159/000539527…
  2 July 2024 12:00 – Mads J B Nordsten

• Two-Year Outcomes of Umbilical Cord Milking in Nonvigorous Infants: A Secondary Analysis of the MINVI Randomized Clinical Trial

  JAMA Netw Open. 2024 Jul 1;7(7):e2416870. doi: 10.1001/jamanetworkopen.2024.16870.ABSTRACTIMPORTANCE: Compared with early cord clamping (ECC), umbilical cord milking (UCM) reduces delivery room cardiorespiratory support, hypoxic-ischemic encephalopathy, and therapeutic hypothermia in nonvigorous near-term and full-term infants. However, UCM postdischarge outcomes are not known.OBJECTIVE: To determine the 2-year outcomes of children randomized to UCM or ECC at birth in the Milking in Nonvigorous Infants (MINVI) trial.DESIGN, SETTING, AND PARTICIPANTS: A secondary analysis to evaluate longer-term outcomes of a cluster-randomized crossover trial was conducted from January 9, 2021, to September 25, 2023. The primary trial took place in 10 medical centers in the US, Canada, and Poland from January 5, 2019, to June 1, 2021, and hypothesized that UCM would reduce admission to the neonatal intensive care unit compared with ECC; follow-up concluded September 26, 2023. The population included near-term and full-term infants aged 35 to 42 weeks' gestation at birth who were nonvigorous; families provided consent to complete developmental screening questionnaires through age 2 years.INTERVENTION: UCM and ECC.MAIN OUTCOMES AND MEASURES: Ages and Stages Questionnaire, 3rd Edition (ASQ-3) and Modified Checklist for Autism in Toddlers, Revised/Follow-Up (M-CHAT-R/F) questionnaires at ages 22 to 26 months. Intention-to-treat analysis and per-protocol analyses were used.RESULTS: Among 1730 newborns from the primary trial, long-term outcomes were evaluated in 971 children (81%) who had ASQ-3 scores available at 2 years or died before age 2 years and 927 children (77%) who had M-CHAT-R/F scores or died before age 2 years. Maternal and neonatal characteristics by treatment group were similar, with median birth gestational age of 39 (IQR, 38-40) weeks in both groups; 224 infants (45%) in the UCM group and 201 (43%) in the ECC group were female. The median ASQ-3 total scores were similar (UCM: 255 [IQR, 225-280] vs ECC: 255 [IQR, 230-280]; P = .87), with no significant differences in the ASQ-3 subdomains. Medium- to high-risk M-CHAT-R/F scores were also similar (UCM, 9% [45 of 486] vs ECC, 8% [37 of 441]; P = .86).CONCLUSIONS AND RELEVANCE: In this secondary analysis of a randomized clinical trial among late near-term and full-term infants who were nonvigorous at birth, ASQ-3 scores at age 2 years were not significantly different between the UCM and ECC groups. Combined with previously reported important short-term benefits, this follow-up study suggests UCM is a feasible, no-cost intervention without longer-term neurodevelopmental risks of cord milking in nonvigorous near-term and term newborns.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03631940.PMID:38949814 | PMC:PMC11217871 | DOI:10.1001/jamanetworkopen.2024.16870…
  1 July 2024 12:00 – Anup C Katheria

• Pregnancy Outcomes of Nifedipine Compared With Labetalol for Oral Treatment of Mild Chronic Hypertension

  Obstet Gynecol. 2024 Jul 1;144(1):126-134. doi: 10.1097/AOG.0000000000005613. Epub 2024 May 23.ABSTRACTOBJECTIVE: To evaluate maternal and neonatal outcomes by type of antihypertensive used in participants of the CHAP (Chronic Hypertension in Pregnancy) trial.METHODS: We conducted a planned secondary analysis of CHAP, an open-label, multicenter, randomized trial of antihypertensive treatment compared with standard care (no treatment unless severe hypertension developed) in pregnant patients with mild chronic hypertension (blood pressure 140-159/90-104 mm Hg before 20 weeks of gestation) and singleton pregnancies. We performed three comparisons based on medications prescribed at enrollment: labetalol compared with standard care, nifedipine compared with standard care, and labetalol compared with nifedipine. Although active compared with standard care groups were randomized, medication assignment within the active treatment group was not random but based on clinician or patient preference. The primary outcome was the occurrence of superimposed preeclampsia with severe features, preterm birth before 35 weeks of gestation, placental abruption, or fetal or neonatal death. The key secondary outcome was small for gestational age (SGA) neonates. We also compared medication adverse effects between groups. Relative risks (RRs) and 95% CIs were estimated with log binomial regression to adjust for confounding.RESULTS: Of 2,292 participants analyzed, 720 (31.4%) received labetalol, 417 (18.2%) received nifedipine, and 1,155 (50.4%) received no treatment. The mean gestational age at enrollment was 10.5±3.7 weeks; nearly half of participants (47.5%) identified as non-Hispanic Black; and 44.5% used aspirin. The primary outcome occurred in 217 (30.1%), 130 (31.2%), and 427 (37.0%) in the labetalol, nifedipine, and standard care groups, respectively. Risk of the primary outcome was lower among those receiving treatment (labetalol use vs standard adjusted RR 0.82, 95% CI, 0.72-0.94; nifedipine use vs standard adjusted RR 0.84, 95% CI, 0.71-0.99), but there was no significant difference in risk when labetalol was compared with nifedipine (adjusted RR 0.98, 95% CI, 0.82-1.18). There were no significant differences in SGA or serious adverse events between participants receiving labetalol and those receiving nifedipine.CONCLUSION: No significant differences in predetermined maternal or neonatal outcomes were detected on the basis of the use of labetalol or nifedipine for treatment of chronic hypertension in pregnancy.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02299414.PMID:38949541 | PMC:PMC11219006 | DOI:10.1097/AOG.0000000000005613…
  1 July 2024 12:00 – Ayodeji A Sanusi

• Management of Spontaneous Vaginal Delivery

  Am Fam Physician. 2024 Jun;109(6):525-532.ABSTRACTPregnancy dating is determined by the patient's last menstrual period or an ultrasound measurement. A full-term pregnancy is considered 37 weeks' gestation or more. Spontaneous labor begins when regular painful uterine contractions result in a cervical change. Active labor begins at 6 cm dilation and is marked by more predictable, accelerated cervical change. In the absence of pregnancy complications, intermittent fetal auscultation may be considered as an alternative to continuous electronic fetal monitoring, which is associated with a high false-positive rate. Intravenous antibiotic prophylaxis is indicated in patients with group B streptococcus colonization or those at high risk to prevent newborn early-onset group B streptococcus. The likelihood of vaginal delivery is increased by providing continuous nonmedical support during labor, encouraging mobility, and using a peanut ball with epidural analgesia. Neuraxial analgesia is more effective for pain control than systemic opioids and is associated with fewer adverse effects. Delayed pushing during the second stage of labor has risks but does not affect the mode of delivery. Routine oropharyngeal suctioning of the newborn is not recommended, even with meconium-stained amniotic fluid. Delayed cord clamping reduces newborn anemia. Prevention of postpartum hemorrhage in patients at risk includes prophylactic uterotonic administration and controlled cord traction. Perineal lacerations that alter anatomy or are not hemostatic should be repaired. (Am Fam Physician. 2024;109(6):525-532.PMID:38905550…
  21 June 2024 12:00 – Kathryn A McKenna

• Impact of early versus delayed umbilical cord clamping on term neonates' haemoglobin levels: a randomized controlled trial

  J Int Med Res. 2024 Jun;52(6):3000605241255836. doi: 10.1177/03000605241255836.ABSTRACTOBJECTIVE: To compare the effects of early and delayed cord clamping on the haemoglobin levels of neonates delivered at term.METHODS: This randomized controlled trial enrolled pregnant women during the second stage of labour. They were randomized into either the early cord clamping (ECC) group or the delayed cord clamping (DCC) group in the ratio of 1:1. Following delivery of the baby, the umbilical cords of participants in the ECC group were clamped within 30 s of delivery of the neonate while those of participants in the DCC group were clamped after 2 min from the delivery of the neonate. The primary outcome measure was the effect of ECC and DCC on the haemoglobin levels of neonates delivered at term.RESULTS: A total of 270 pregnant women were enrolled in the study. Their baseline sociodemographic and clinical characteristics were similar in both groups. There was no significant difference in the mean haemoglobin level between ECC and DCC groups at birth. The mean haemoglobin level of the neonates at 48 h postpartum was significantly higher in the DCC group than the ECC group.CONCLUSION: DCC at birth was associated with a significant increase in neonatal haemoglobin levels at 48 h postpartum when compared with ECC.Trial Registration: The trial was registered at Pan African Clinical Trial Registry with approval number PACTR202206735622089.PMID:38851870 | PMC:PMC11162598 | DOI:10.1177/03000605241255836…
  9 June 2024 12:00 – Kelechi P Enyinna

• Comparison of Three Methods of Umbilical Cord Management in Late Preterm and Term Newborns on Hemoglobin and Ferritin Levels at Six Weeks of Age: A Randomized Controlled Trial

  Cureus. 2024 Apr 26;16(4):e59046. doi: 10.7759/cureus.59046. eCollection 2024 Apr.ABSTRACTBACKGROUND: Umbilical cord milking (UCM) and delayed cord clamping (DCC) are strategies that improve the hemodynamic condition of the newborn and also increase the storage of iron. This study aimed to compare the effects of DCC with or without milking in late preterm and term neonates at different time intervals after birth (60, 120, and 180 seconds) on hematological and hemodynamic parameters in neonates at six weeks of age.MATERIALS AND METHODS: In this double-arm, parallel-group, triple-blind, and active-controlled trial, all 150 eligible neonates were randomized with allocation concealment into three groups: Group A (DCC with UCM at 60 seconds), Group B (DCC with UCM at 120 seconds), and Group C (only DCC for 180 seconds). Hemodynamic parameters were recorded and compared during the first 48 hours, and hematological parameters were compared at six weeks of age.RESULTS: At six weeks, a significant difference in hemoglobin levels was noted between Groups A, B, and C (p<0.001). The difference in serum ferritin values at six weeks was also statistically significant in comparisons across all three groups (p=0.003). Regarding secondary outcomes examined, hemodynamic parameters and the incidence of neonatal hyperbilirubinemia were found to be comparable at 48 hours after birth.CONCLUSION: DCC followed by UCM at 120 seconds and DCC till 180 seconds proves superior to DCC with UCM at 60 seconds in preserving elevated hemoglobin levels and iron stores in neonates at six weeks of age. DCC for 180 seconds yielded comparable results, followed by UCM at 120 seconds. All three methods are considered safe and effective without compromising the neonate's hemodynamics.PMID:38800297 | PMC:PMC11128072 | DOI:10.7759/cureus.59046…
  27 May 2024 12:00 – Brajendra Singh

• Mean Arterial Pressure and Neonatal Outcomes in Pregnancies Complicated by Mild Chronic Hypertension

  Obstet Gynecol. 2024 Jul 1;144(1):101-108. doi: 10.1097/AOG.0000000000005611. Epub 2024 May 23.ABSTRACTOBJECTIVE: To estimate the association between mean arterial pressure during pregnancy and neonatal outcomes in participants with chronic hypertension using data from the CHAP (Chronic Hypertension and Pregnancy) trial.METHODS: A secondary analysis of the CHAP trial, an open-label, multicenter randomized trial of antihypertensive treatment in pregnancy, was conducted. The CHAP trial enrolled participants with mild chronic hypertension (blood pressure [BP] 140-159/90-104 mm Hg) and singleton pregnancies less than 23 weeks of gestation, randomizing them to active treatment (maintained on antihypertensive therapy with a goal BP below 140/90 mm Hg) or standard treatment (control; antihypertensives withheld unless BP reached 160 mm Hg systolic BP or higher or 105 mm Hg diastolic BP or higher). We used logistic regression to measure the strength of association between mean arterial pressure (average and highest across study visits) and to select neonatal outcomes. Unadjusted and adjusted odds ratios (per 1-unit increase in millimeters of mercury) of the primary neonatal composite outcome (bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, or intraventricular hemorrhage grade 3 or 4) and individual secondary outcomes (neonatal intensive care unit admission [NICU], low birth weight [LBW] below 2,500 g, and small for gestational age [SGA]) were calculated.RESULTS: A total of 2,284 participants were included: 1,155 active and 1,129 control. Adjusted models controlling for randomization group demonstrated that increasing average mean arterial pressure per millimeter of mercury was associated with an increase in each neonatal outcome examined except NEC, specifically neonatal composite (adjusted odds ratio [aOR] 1.12, 95% CI, 1.09-1.16), NICU admission (aOR 1.07, 95% CI, 1.06-1.08), LBW (aOR 1.12, 95% CI, 1.11-1.14), SGA below the fifth percentile (aOR 1.03, 95% CI, 1.01-1.06), and SGA below the 10th percentile (aOR 1.02, 95% CI, 1.01-1.04). Models using the highest mean arterial pressure as opposed to average mean arterial pressure also demonstrated consistent associations.CONCLUSION: Increasing mean arterial pressure was positively associated with most adverse neonatal outcomes except NEC. Given that the relationship between mean arterial pressure and adverse pregnancy outcomes may not be consistent at all mean arterial pressure levels, future work should attempt to further elucidate whether there is an absolute threshold or relative change in mean arterial pressure at which fetal benefits are optimized along with maternal benefits.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT02299414.PMID:38781591 | PMC:PMC11216857 | DOI:10.1097/AOG.0000000000005611…
  23 May 2024 12:00 – Matthew D Moore

• Measuring direct effect of cord clamping approaches: getting the right target group

  Pediatr Res. 2024 Jul;96(1):5-6. doi: 10.1038/s41390-024-03284-3. Epub 2024 May 20.NO ABSTRACTPMID:38769402 | DOI:10.1038/s41390-024-03284-3…
  20 May 2024 12:00 – Arjan Te Pas

• Ventilatory Assistance Before Umbilical Cord Clamping in Extremely Preterm Infants: A Randomized Clinical Trial

  JAMA Netw Open. 2024 May 1;7(5):e2411140. doi: 10.1001/jamanetworkopen.2024.11140.ABSTRACTIMPORTANCE: Providing assisted ventilation during delayed umbilical cord clamping may improve outcomes for extremely preterm infants.OBJECTIVE: To determine whether assisted ventilation in extremely preterm infants (23 0/7 to 28 6/7 weeks' gestational age [GA]) followed by cord clamping reduces intraventricular hemorrhage (IVH) or early death.DESIGN, SETTING, AND PARTICIPANTS: This phase 3, 1:1, parallel-stratified randomized clinical trial conducted at 12 perinatal centers across the US and Canada from September 2, 2016, through February 21, 2023, assessed IVH and early death outcomes of extremely preterm infants randomized to receive 120 seconds of assisted ventilation followed by cord clamping vs delayed cord clamping for 30 to 60 seconds with ventilatory assistance afterward. Two analysis cohorts, not breathing well and breathing well, were specified a priori based on assessment of breathing 30 seconds after birth.INTERVENTION: After birth, all infants received stimulation and suctioning if needed. From 30 to 120 seconds, infants randomized to the intervention received continuous positive airway pressure if breathing well or positive-pressure ventilation if not, with cord clamping at 120 seconds. Control infants received 30 to 60 seconds of delayed cord clamping followed by standard resuscitation.MAIN OUTCOMES AND MEASURES: The primary outcome was any grade IVH on head ultrasonography or death before day 7. Interpretation by site radiologists was confirmed by independent radiologists, all masked to study group. To estimate the association between study group and outcome, data were analyzed using the stratified Cochran-Mantel-Haenszel test for relative risk (RR), with associations summarized by point estimates and 95% CIs.RESULTS: Of 1110 women who consented to participate, 548 were randomized and delivered infants at GA less than 29 weeks. A total of 570 eligible infants were enrolled (median [IQR] GA, 26.6 [24.9-27.7] weeks; 297 male [52.1%]). Intraventricular hemorrhage or death occurred in 34.9% (97 of 278) of infants in the intervention group and 32.5% (95 of 292) in the control group (adjusted RR, 1.02; 95% CI, 0.81-1.27). In the prespecified not-breathing-well cohort (47.5% [271 of 570]; median [IQR] GA, 26.0 [24.7-27.4] weeks; 152 male [56.1%]), IVH or death occurred in 38.7% (58 of 150) of infants in the intervention group and 43.0% (52 of 121) in the control group (RR, 0.91; 95% CI, 0.68-1.21). There was no evidence of differences in death, severe brain injury, or major morbidities between the intervention and control groups in either breathing cohort.CONCLUSIONS AND RELEVANCE: This study did not show that providing assisted ventilation before cord clamping in extremely preterm infants reduces IVH or early death. Additional study around the feasibility, safety, and efficacy of assisted ventilation before cord clamping may provide additional insight.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02742454.PMID:38758557 | PMC:PMC11102017 | DOI:10.1001/jamanetworkopen.2024.11140…
  17 May 2024 12:00 – Karen D Fairchild

• Effect of administration routes of oxytocin on hemoglobin in neonates with delayed umbilical cord clamping: a multi-centre randomized controlled clinical trial

  Arch Gynecol Obstet. 2024 Aug;310(2):991-999. doi: 10.1007/s00404-024-07543-w. Epub 2024 May 16.ABSTRACTPURPOSE: To evaluate the effect of intravenous infusion versus intramyometrial injection of oxytocin on hemoglobin levels in neonates with delayed umbilical cord clamping during cesarean section.METHODS: The multi-centre randomized controlled trial was performed at three hospitals from February to June 2023. Women with term singleton gestations scheduled for cesarean delivery were allocated to receive an intravenous infusion of 10 units of oxytocin or a myometrial injection of 10 units of oxytocin during the surgery. The primary outcome was neonatal hemoglobin at 48 to 96 h after birth. Secondary outcomes were side-effects of oxytocin, postpartum haemorrhage, phototherapy for jaundice, feeding at 1 month, maternal and neonatal morbidity and re-admissions.RESULTS: A total of 360 women were randomized (180 women in each group). The mean neonatal hemoglobin did not show a significant difference between the intravenous infusion group (194.3 ± 21.7 g/L) and the intramyometrial groups (195.2 ± 24.3 g/L) (p = 0.715). Secondary neonatal outcomes, involving phototherapy for jaundice, feeding at 1 month and neonatal intensive care unit admission were similar between the two groups. The maternal outcomes did not differ significantly between the two groups, except for a 200 mL higher intraoperative infusion volume observed in the intravenous group compared to the intramyometrial group.CONCLUSION: Among women undergoing elective cesarean delivery of term singleton pregnancies, there was no significant difference in neonatal hemoglobin at 48 to 96 h after birth between infants with delayed cord clamping, whether the oxytocin was administrated by intravenous infusion or intramyometrial injection.TRIAL REGISTRATION: Chinese Clinical trial registry: ChiCTR2300067953 (1 February 2023).PMID:38753205 | PMC:PMC11258157 | DOI:10.1007/s00404-024-07543-w…
  16 May 2024 12:00 – Lu Mei

• Neonatal Resuscitation Practices in Portuguese Delivery Rooms: A Cross-Sectional Study

  Acta Med Port. 2024 May 2;37(5):342-354. doi: 10.20344/amp.20009. Epub 2024 May 2.ABSTRACTINTRODUCTION: Data from previous studies have demonstrated inconsistency between current evidence and delivery room resuscitation practices in developed countries. The primary aim of this study was to assess the quality of newborn healthcare and resuscitation practices in Portuguese delivery rooms, comparing current practices with the 2021 European Resuscitation Council guidelines. The secondary aim was to compare the consistency of practices between tertiary and non-tertiary centers across Portugal.METHODS: An 87-question survey concerning neonatal care was sent to all physicians registered with the Portuguese Neonatal Society via email. In order to compare practices between centers, participants were divided into two groups: Group A (level III and level IIb centers) and Group B (level IIa and I centers). A descriptive analysis of variables was performed in order to compare the two groups.RESULTS: In total, 130 physicians responded to the survey. Group A included 91 (70%) and Group B 39 (30%) respondents. More than 80% of participants reported the presence of a healthcare professional with basic newborn resuscitation training in all deliveries, essential equipment in the delivery room, such as a resuscitator with a light and heat source, a pulse oximeter, and an O2 blender, and performing delayed cord clamping for all neonates born without complications. Less than 60% reported performing team briefing before deliveries, the presence of electrocardiogram sensors, end-tidal CO2 detector, and continuous positive airway pressure in the delivery room, and monitoring the neonate's temperature. Major differences between groups were found regarding staff attending deliveries, education, equipment, thermal control, umbilical cord management, vital signs monitoring, prophylactic surfactant administration, and the neonate's transportation out of the delivery room.CONCLUSION: Overall, adherence to neonatal resuscitation international guidelines was high among Portuguese physicians. However, differences between guidelines and current practices, as well as between centers with different levels of care, were identified. Areas for improvement include team briefing, ethics, education, available equipment in delivery rooms, temperature control, and airway management. The authors emphasize the importance of continuous education to ensure compliance with the most recent guidelines and ultimately improve neonatal health outcomes.PMID:38744237 | DOI:10.20344/amp.20009…
  14 May 2024 12:00 – Natacha Alves

• Newborns at risk of COVID-19, the story continues

  J Perinat Med. 2024 May 15;52(6):567-574. doi: 10.1515/jpm-2024-0125. Print 2024 Jul 26.ABSTRACTAfter more than 4 years of the SARS-CoV-2 pandemic, a great deal of knowledge on how this virus affects pregnant women, the fetus and the newborn has accumulated. Guidelines for mode of delivery, cord clamping, skin to skin, breastfeeding, and rooming-in have become uniform across the world. Vaccination has considerably improved outcomes, but hesitancy amongst pregnant patients and the emergence of variants remain challenged and SARS-CoV-2 positivity during pregnancy continues to be associated with an increased risk of maternal complications, premature delivery and higher neonatal mortality and morbidity. An emerging body of data now exists on the effect of SARS-CoV-2 in pregnancy on early neonatal outcomes, medical education in obstetrics and pediatrics, and longer-term developmental outcomes. In this article, we review the development in this field since our last review.PMID:38742624 | DOI:10.1515/jpm-2024-0125…
  14 May 2024 12:00 – Malika D Shah

• Effect of Delayed Cord Clamping on Breastfeeding Behaviors During the First Breastfeed: A Randomized Controlled Study

  Breastfeed Med. 2024 May 13. doi: 10.1089/bfm.2024.0080. Online ahead of print.ABSTRACTObjective: Delayed cord clamping (DCC) may increase the success of breastfeeding by improving neurological and cardiovascular function in neonates. In this study, we investigated the impact of DCC on breastfeeding behaviors, neonatal activity status, and maternal satisfaction during the first breastfeeding. Methods: This randomized controlled study was conducted in a tertiary hospital in Turkey with 100 term infants delivered by elective cesarean section with spinal anesthesia. The participants were randomly assigned to the early cord clamping (ECC) group or DCC group. The Infant Breastfeeding Assessment Tool (IBFAT) was used to assess infant alertness, breastfeeding behaviors, and maternal satisfaction with breastfeeding within the first 2 hours of life. Results: Scores on the IBFAT were significantly higher in the DCC group compared with the ECC group (p = 0.02). Maternal satisfaction with breastfeeding did not differ between the groups (p = 0.3). Infant alertness tended to be better in the DCC group, but the difference was not statistically significant (p = 0.08). Conclusion: The results of this study indicated that DCC was associated with more favorable breastfeeding behaviors compared with ECC.PMID:38738940 | DOI:10.1089/bfm.2024.0080…
  13 May 2024 12:00 – Nihan Hilal Hoşağası

• Persistent omphalomesenteric duct in an infant with trisomy 21

  BMJ Case Rep. 2024 May 8;17(5):e259671. doi: 10.1136/bcr-2024-259671.ABSTRACTWe present the case of a term newborn with trisomy 21 who presented to the paediatric emergency department with periumbilical flare and green-brown discharge from a clamped umbilical cord, initially suspected to be omphalitis. However, it was noticed later, that when the infant strained or cried, a thick, bubbling and offensive green-brown discharge came out of the clamped umbilical cord with umbilical flatus. An ultrasound abdomen and umbilical cord confirmed the presence of a persistent omphalomesenteric duct (POMD). He was then transferred to the paediatric surgical unit. There, he underwent a laparotomy and surgical resection of the POMD and was discharged home 2 days later.PMID:38719262 | PMC:PMC11085785 | DOI:10.1136/bcr-2024-259671…
  8 May 2024 12:00 – Arameh Aghababaie

• OBSTRUCTED CONGENITAL HERNIA OF UMBILICAL CORD IN A NIGERIAN NEWBORN AND ITS DIAGNOSTIC CONUNDRUM

  Ann Ib Postgrad Med. 2023 Dec;21(3):75-78. Epub 2024 Jan 30.ABSTRACTBACKGROUND: Congenital Hernia of umbilical cord (CHUC) is a rare presentation. The failure of return of intestinal loops following physiological herniation has been postulated as the embryological basis of this condition. This is usually mistakenly termed as omphalocele minor. We aim to highlight this rare finding, the clinical features, diagnostic dilemma, and management of CHUC.CASE PRESENTATION: He is a 4-day old male with obstructed CHUC. He had an oedematous umbilical stump, with circumferential normal abdominal wall skin folds in the form of a collar wrapping round the proximal aspect of the protrusion. The umbilical defect measured about 4 cm in diameter. Subsequently, surgical reduction and repair of defect was done, with resolution of symptoms.CONCLUSION: CHUC though a rare entity and easily missed, accurate diagnosis and management offer good prognosis. Also, recognition will prevent iatrogenic bowel injury from careless clamping of the cord with associated morbidity and mortality. It also helps to prevent mis categorization and prevent unwarranted anxiety with misdiagnosis.PMID:38706623 | PMC:PMC11065190…
  6 May 2024 12:00 – A A Ishola

• Quality improvement efforts directed at optimal umbilical cord management in delivery room

  Semin Perinatol. 2024 Apr;48(3):151905. doi: 10.1016/j.semperi.2024.151905. Epub 2024 Apr 19.ABSTRACTDelayed or deferred cord clamping (DCC) and umbilical cord milking (UCM) benefit all infants by optimizing fetal-neonatal transition and placental transfusion. Even though DCC is recommended by almost all maternal and neonatal organizations, it has not been universally implemented. There is considerable variation in umbilical cord management practices across institutions. In this article, we provide examples of successful quality improvement (QI) initiatives to implement optimal cord management in the delivery room. We discuss a number of key elements that should be considering among those undertaking QI efforts to implement DCC and UCM including, multidisciplinary team collaboration, development of theory for change, mapping of the current and ideal process and workflow for cord management, and creation of a unit-specific evidence-based protocol for cord management. We also examine important strategies for implementation and provide suggestions for developing a system for measurement and benchmarking.PMID:38679508 | DOI:10.1016/j.semperi.2024.151905…
  28 April 2024 12:00 – Priya Jegatheesan

• How does maternal anemia affect the levels of umbilical cord brain-derived neurotrophic factor?

  Eur J Obstet Gynecol Reprod Biol. 2024 Jun;297:182-186. doi: 10.1016/j.ejogrb.2024.04.016. Epub 2024 Apr 19.ABSTRACTOBJECTIVE: In this study, we aimed to evaluate the effect of maternal iron deficiency anemia on the umbilical cord level of brain-derived neurotrophic factor (BDNF), which plays a very important role in the central nervous system.METHODS: Our research was planned as a quantitative, prospective, and analytical type of study. A total of 90 volunteers, term, singleton pregnant hospitalized in the Health Sciences University Ümraniye Training and Research Hospital Gynecology and Obstetrics Clinic between September 2021 and August 2022 were included in this study. While 45 of these pregnants were pregnant women with iron deficiency anemia (hemoglobin ≤ 110 g/L and serum ferritin level ≤ 12 μg/L), 45 cases were in the control group without iron deficiency anemia (hemoglobin > 110 g/L, serum ferritin > 12 μg/L). When pregnant were admitted to the hospital, blood samples were taken to analyze hemoglobin, mean cell volume (MCV), iron, unsaturated iron binding capacity, total iron binding capacity, serum ferritin, transferrin, and CRP levels. Also, we noted the maternal age, gravida, parity, birth weight, head circumference, type of birth, 1. minute Apgar score, and 5. minute Apgar score. During the delivery; after the umbilical cord had been clamped and cut, we took 5 cc of umbilical cord blood. Then, we put it in the serum-separating laboratory tubes. After we centrifuged these blood samples, we put the serum parts in the Eppendorf tubes to be stored at -80 degrees Celsius. At the end of the study, we calculated the level of BDNF using special human brain-derived neurotrophic factor ELISA kits. The umbilical cord BDNF levels of the maternal iron deficiency anemia group and the control group were compared statistically.RESULTS: When we evaluated the fetal umbilical cord BDNF values of 90 participants, the median value BDNF in the babies of 45 anemic mothers was 3.16 (IQR 0.73), and the median BDNF value of the babies of 45 healthy mothers was 5.37 (IQR 1.02). We found a statistical difference between BDNF and hemoglobin, hematocrit, MCV, and iron values between these two groups.CONCLUSION: In conclusion, the BDNF value of the babies of healthy individuals is higher than that of anemic individuals. Our study showed that the amount of BDNF in the umbilical cord blood was significantly affected by maternal iron deficiency anemia.PMID:38677095 | DOI:10.1016/j.ejogrb.2024.04.016…
  27 April 2024 12:00 – Gökçe İpek Aytok

• Does delayed cord clamping result in higher maternal blood loss in primary cesarean sections? A retrospective comparative study

  J Perinat Med. 2024 Apr 29;52(5):494-500. doi: 10.1515/jpm-2023-0450. Print 2024 Jun 25.ABSTRACTOBJECTIVES: The University Hospital Basel implemented delayed umbilical cord clamping of 30-60 s in all laboring women on April 1, 2020. This practice has been widely researched showing substantial benefit for the neonate. Few studies focused on maternal blood loss. The objective of our retrospective comparative study was to assess the impact of immediate vs. delayed cord clamping on maternal blood loss in primary scheduled cesarean sections.METHODS: We analyzed data of 98 women with singleton gestations undergoing primary scheduled cesarean section at term. Data from procedures with early cord clamping (ECC) were compared to those after implementation of delayed cord clamping (DCC). Primary outcomes were perioperative change in maternal hemoglobin levels, estimated and calculated blood loss. Secondary outcomes included duration of cesarean section and neonatal data.RESULTS: There was a statistically significant difference in the mean perioperative decline of hemoglobin of 10.4 g/L (SD=7.92) and 18.7 g/L (SD=10.4) between the ECC and DCC group, respectively (p<0.001). The estimated (482 mL in ECC vs. 566 mL in DCC (p=0.011)) and the calculated blood loss (438 mL in ECC vs. 715 mL in DCC (p=0.002)) also differed significantly. Secondary outcomes showed no significant differences.CONCLUSIONS: In our study DCC resulted in a statistically significant higher maternal blood loss. In our opinion the widely researched neonatal benefit of DCC outweighs the risk of higher maternal blood loss in low-risk patients. However, maternal risks must be minimized, improvements to preoperative blood management and operative techniques are required.PMID:38676940 | DOI:10.1515/jpm-2023-0450…
  27 April 2024 12:00 – Fabia L Urech

• Blood pressure and cerebral oxygenation with physiologically-based cord clamping: sub-study of the BabyDUCC trial

  Pediatr Res. 2024 Jul;96(1):124-131. doi: 10.1038/s41390-024-03131-5. Epub 2024 Apr 26.ABSTRACTBACKGROUND: Cord-clamping strategies may modify blood pressure (BP) and cerebral tissue oxygen saturation (rStO2) immediately after birth.METHODS: We conducted a sub-study nested within the Baby-Directed Umbilical Cord-Clamping trial. Infants ≥32+0 weeks' gestation assessed as requiring resuscitation were randomly allocated to either physiologically-based cord clamping (PBCC), where resuscitation commenced prior to umbilical cord clamping, or standard care where cord clamping occurred early (ECC). In this single-site sub-study, we obtained additional measurements of pre-ductal BP and rStO2. In a separate observational arm, non-randomised vigorous infants received 2 min of deferred cord clamping (DCC) and contributed data for reference percentiles.RESULTS: Among 161 included infants, n = 55 were randomly allocated to PBCC (n = 30) or ECC (n = 25). The mean (SD) BP at 3-4 min after birth (primary outcome) in the PBCC group was 64 (10) mmHg compared to 62 (10) mmHg in the ECC group, mean difference 2 mmHg (95% confidence interval -3-8 mmHg, p = 0.42). BP and rStO2 were similar across both randomised arms and the observational arm (n = 106).CONCLUSION: We found no difference in BP or rStO2 with the different cord clamping strategies. We report reference ranges for BP and rStO2 for late-preterm and full-term infants receiving DCC.IMPACT: Among late-preterm and full-term infants receiving varying levels of resuscitation, blood pressure (BP, at 3-4 minutes and 6 min) and cerebral tissue oxygen saturation (rStO2) are not influenced by timing of cord clamping in relation to establishment of ventilation. Infants in this study did not require advanced resuscitation, where cord clamping strategies may yet influence BP and rStO2. The reference ranges for BP and rStO2 represent the first, to our knowledge, for vigorous late-preterm and full-term infants receiving deferred cord clamping. rStO2 > 90% (~90th percentile) may be used to define cerebral hyperoxia, for instance when studying oxygen supplementation after birth.PMID:38671085 | PMC:PMC11257956 | DOI:10.1038/s41390-024-03131-5…
  26 April 2024 12:00 – Shiraz Badurdeen

• Impact of shared decision-making on women's childbirth preferences: A cluster randomised controlled trial

  Midwifery. 2024 Jun;133:103999. doi: 10.1016/j.midw.2024.103999. Epub 2024 Apr 12.ABSTRACTBACKGROUND: Midwives provide counselling for birth plans (BPs) to women during prenatal care; however, the impact of individualised BP counselling interventions based on shared decision-making (SDM) regarding women's preferences is unknown.METHODS: This randomised cluster trial included four primary healthcare units. Midwives provided BP counselling based on SDM to women in the intervention group (IG) during prenatal care along with a handout about evidence-based recommendations. Women in the control group (CG) received standard BP counselling from midwives. The main outcome was preference changes concerning BPs.RESULTS: A total of 461 (95.5 %) pregnant women received BP counselling (IG, n = 247; CG, n = 214). Women in the IG changed their BP preferences for 13 items compared with those in the CG. These items were: using an unique space during birth (81.1 % vs 51.6 %; p < 0.001), option for light graduation (63 % vs 44.7 %; p < 0.001), listening to music (57.3 % vs 43.6 %; p = 0.006), drinking fluids during labour (84.6 % vs 93.6 %; p = 0.005), continuous monitoring (59 % vs 37.8 %; p < 0.001); desire for natural childbirth (36.6 % vs 25 %; p = 0.014), epidural analgesia (55.1 % vs 43.6 %; p = 0.023); breathing techniques (65.2 % vs 50.5 %; p = 0.003), massage (74.9 % vs 55.3 %; p < 0.001); birthing ball use (81.9 % vs 56.9 %; p < 0.001), spontaneous pushing (49.3 % vs 28.7 %; p < 0.001), choosing birth position (69.6 % vs 41.5 %) and delayed umbilical cord clamping (67.8 % vs 44.1 %; p = 0.001).CONCLUSION: SDM counselling, together with a handout about evidence-based recommendations on childbirth and newborn care, produced more changes in women's preferences expressed in the BP than standard counselling.PMID:38643600 | DOI:10.1016/j.midw.2024.103999…
  21 April 2024 12:00 – Encarnación López-Gimeno

• Delayed cord clamping and the response to bradycardia immediately after birth

  Arch Dis Child Fetal Neonatal Ed. 2024 Jun 19;109(4):346-347. doi: 10.1136/archdischild-2023-326398.NO ABSTRACTPMID:38641420 | DOI:10.1136/archdischild-2023-326398…
  19 April 2024 12:00 – Jackie Patterson

• Deferred cord clamping and polythene bags at delivery: measuring and improving quality

  Arch Dis Child Fetal Neonatal Ed. 2024 Jun 19;109(4):344-345. doi: 10.1136/archdischild-2023-326702.NO ABSTRACTPMID:38641419 | DOI:10.1136/archdischild-2023-326702…
  19 April 2024 12:00 – Katherine Jane Pettinger

• Achieving optimal cord management: a multidisciplinary quality improvement initiative

  BMJ Open Qual. 2024 Apr 15;13(2):e002662. doi: 10.1136/bmjoq-2023-002662.ABSTRACTOptimal cord management (OCM), defined as waiting at least 60 seconds (s) before clamping the umbilical cord after birth, is an evidence-based intervention that improves outcomes for both term and preterm babies. All major resuscitation councils recommend OCM for well newborns.National Neonatal Audit Programme (NNAP) benchmarking data identified our tertiary neonatal unit as a negative outlier with regard to OCM practice with only 12.1% of infants receiving the recommended minimum of 60 s. This inspired a quality improvement project (QIP) to increase OCM rates of ≥ 60 s for infants <34 weeks. A multidisciplinary QIP team (Neonatal medical and nursing staff, Obstetricians, Midwives and Anaesthetic colleagues) was formed, and robust evidence-based quality improvement methodologies employed. Our aim was to increase OCM of ≥ 60 s for infants born at <34 weeks to at least 40%.The percentage of infants <34 weeks receiving OCM increased from 32.4% at baseline (June-September 2022) to 73.6% in the 9 months following QIP commencement (October 2022-June 2023). The intervention period spanned two cohorts of rotational doctors, demonstrating its sustainability. Rates of admission normothermia were maintained following the routine adoption of OCM (89.2% vs 88.5%), which is a complication described by other neonatal units.This project demonstrates the power of a multidisciplinary team approach to embedding an intervention that relies on collaboration between multiple departments. It also highlights the importance of national benchmarking data in allowing departments to focus QIP efforts to achieve long-lasting transformational service improvements.PMID:38626936 | PMC:PMC11029183 | DOI:10.1136/bmjoq-2023-002662…
  16 April 2024 12:00 – Jessica Burgess-Shannon

• Successful management of fetal hypoxia due to amniotic banding at 26 weeks of pregnancy: A case report of a rare survival

  Eur J Obstet Gynecol Reprod Biol. 2024 Jun;297:264-266. doi: 10.1016/j.ejogrb.2024.04.010. Epub 2024 Apr 14.ABSTRACTBACKGROUND: Amniotic banding is a rare condition that can lead to structural limb anomalies, fetal distress and adverse obstetric outcomes. The main hypothesis for its etiology is a rupture of the amniotic membrane in early pregnancy, with the formation of tightly entangling strands around the fetus. These strands can constrict, incise, and subsequently amputate limb parts, the neck or head. More rarely, the amniotic banding can affect the umbilical cord, leading to fetal distress or potential intra-uterine fetal demise.OBJECTIVE: We present a unique case of a 26-week pregnant woman who attended a polyclinical consultation due to reduced fetal movements with concerning cardiotocography (CTG) findings. A review of the literature about amniotic banding of the umbilical cord was conducted as well, identifying diagnostic and interventional options for the obstetrician's practice.STUDY DESIGN: This is a case report, alongside a review of the literature.RESULTS: The CTG indicated fetal distress, prompting an emergency caesarean section (C-section). Upon delivery, the neonate exhibited signs of amniotic band sequence, with distal phalangeal defects on the right hand and severe constriction of the umbilical cord caused by amniotic strands, the latter precipitating fetal hypoxia. Direct ultrasound diagnosis remains a challenge in the absence of limb amputation, yet indirect signs such as distal limb or umbilical doppler flow abnormalities and distal limb edema may be suggestive of amniotic banding. MRI is proposed as an adjuvant diagnostic tool yet does not present a higher detection rate compared to ultrasound. Fetoscopic surgery to perform lysis of the amniotic strands with favorable outcome has been described in literature.CONCLUSION: This case presents the first reported survival of an extremely preterm fetus in hypoxic distress as a cause of amniotic banding of the umbilical cord, with a rare degree of incidental timing. Ultrasound diagnosis remains the gold standard. Obstetrical vigilance is warranted, with fetal rescue proven to be feasible.PMID:38616145 | DOI:10.1016/j.ejogrb.2024.04.010…
  14 April 2024 12:00 – Florian Waerlop

• Influence of umbilical cord clamping time on cerebral oxygenation and early cardiac function in term infants

  J Neonatal Perinatal Med. 2024 Apr 6. doi: 10.3233/NPM-230223. Online ahead of print.ABSTRACTBACKGROUND: Delayed cord clamping is the standard of care for both term and preterm infants worldwide. The aim of this study was to evaluate the effect of 60-second or 180-second delayed cord clamping during labor on cerebral oxygenation and cardiac function.METHODS: Healthy newborns were divided into two groups: a 60-second delay in cord clamping (60-s DCC) and a 180-second delay in cord clamping (180-s DCC) at birth. Pulse oximetry and cerebral near-infrared spectroscopy (cNIRS) probes were placed during postnatal care. A total of 84 healthy newborns were included in this study. Preductal oxygen saturation (SpO2), heart rate, and cNIRS values were recorded at 5 and 10 minutes after delivery. The cardiac function of the infants was assessed by echocardiography at 3-7 days postnatally.RESULTS: There was no significant difference between the groups in SpO2 and cNIRS values at 5 and 10 min. While there was no significant difference in the number of neonates with targeted SpO2 at the 5th and 10th min and targeted cNIRS values at the 10th min, there was a significant difference in the number of neonates with target cNIRS values at the 5th min between groups (p < 0.001). Echocardiographic findings showed that pulmonary flow velocity was increased in the 180-s DCC group; the difference was statistically significant (p = 0.04).CONCLUSION: Our results showed that the number of infants with normal cNIRS values regarding cerebral oxygenation was higher in the 180-s DCC group. The pulmonary flow velocity was significantly increased in the 180-s DCC group in terms of echocardiographic findings.PMID:38607769 | DOI:10.3233/NPM-230223…
  12 April 2024 12:00 – M Satar

• How long is too long? No added benefit with prolonged ventilation with intact cord in preterm infants

  J Physiol. 2024 Apr;602(8):1663-1664. doi: 10.1113/JP286492. Epub 2024 Apr 11.NO ABSTRACTPMID:38602842 | PMC:PMC11090468 | DOI:10.1113/JP286492…
  11 April 2024 12:00 – Anup Katheria

• Umbilical cord milking and delayed cord clamping for the prevention of neonatal hypoglycaemia: a systematic review and meta-analysis

  BMC Pregnancy Childbirth. 2024 Apr 8;24(1):248. doi: 10.1186/s12884-024-06427-w.ABSTRACTBACKGROUND: Placental management strategies such as umbilical cord milking and delayed cord clamping may provide a range of benefits for the newborn. The aim of this review was to assess the effectiveness of umbilical cord milking and delayed cord clamping for the prevention of neonatal hypoglycaemia.METHODS: Three databases and five clinical trial registries were systematically reviewed to identify randomised controlled trials comparing umbilical cord milking or delayed cord clamping with control in term and preterm infants. The primary outcome was neonatal hypoglycaemia (study defined). Two independent reviewers conducted screening, data extraction and quality assessment. Quality of the included studies was assessed using the Cochrane Risk of Bias tool (RoB-2). Certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Meta-analysis using a random effect model was done using Review Manager 5.4. The review was registered prospectively on PROSPERO (CRD42022356553).RESULTS: Data from 71 studies and 14 268 infants were included in this review; 22 (2 537 infants) compared umbilical cord milking with control, and 50 studies (11 731 infants) compared delayed with early cord clamping. For umbilical cord milking there were no data on neonatal hypoglycaemia, and no differences between groups for any of the secondary outcomes. We found no evidence that delayed cord clamping reduced the incidence of hypoglycaemia (6 studies, 444 infants, RR = 0.87, CI: 0.58 to 1.30, p = 0.49, I2 = 0%). Delayed cord clamping was associated with a 27% reduction in neonatal mortality (15 studies, 3 041 infants, RR = 0.73, CI: 0.55 to 0.98, p = 0.03, I2 = 0%). We found no evidence for the effect of delayed cord clamping for any of the other outcomes. The certainty of evidence was low for all outcomes.CONCLUSION: We found no data for the effectiveness of umbilical cord milking on neonatal hypoglycaemia, and no evidence that delayed cord clamping reduced the incidence of hypoglycaemia, but the certainty of the evidence was low.PMID:38589786 | PMC:PMC11000397 | DOI:10.1186/s12884-024-06427-w…
  8 April 2024 12:00 – Estelle D Watson

• A randomised controlled trial comparing umbilical cord milking to delayed cord clamping at birth in preterm infants 28-36 weeks gestational age

  Eur J Pediatr. 2024 Jun;183(6):2791-2796. doi: 10.1007/s00431-024-05550-2. Epub 2024 Apr 6.ABSTRACTDelayed cord clamping (DCC) is an established practice in perinatology with multiple benefits. However, in instances where the implementation of DCC is not viable, it needs alternatives, especially during caesarean deliveries. A non-inferiority randomized, non-blinded, trial was conducted at a tertiary care referral unit in South India among the preterm newborns (28-36 weeks) randomized to DCC as opposed to intact-umbilical cord milking (UCM). The primary objective was to compare the mean haemoglobin values between the two groups, and the secondary outcome was to compare death and/or major IVH (> Grade II). Of the 132 eligible newborn infants, 99 were randomized to two study groups. Of the 59 and 40 randomised to UCM and DCC, 54 and 36 received the allocated intervention respectively. Preterm infants who underwent UCM had significantly higher haemoglobin (19.97 ± 1.44) as compared to DCC group (18.62 ± 0.98) p-0.0001. The rates of mortality and/or major IVH were comparable between the two groups.CONCLUSION: UCM may be a feasible alternative to DCC especially in settings where the latter is not achievable, without increasing the risk of adverse effects to the preterm infants, this finding needing further confirmation with larger sample.TRIAL REGISTRATION: CTRI (Clinical Trial Registry-India) registration number: CTRI/2020/04/024566 (registered prospectively on 13/04/2020).WHAT IS KNOWN: • Delayed cord clamping (DCC) is recommended as a standard of care for all the stable term and preterm newborn babies at birth.WHAT IS NEW: • Intact umbilical cord milking may be a reasonable choice of cord management when DCC is unsuccessful, without increasing adverse effects for the new born.PMID:38581461 | DOI:10.1007/s00431-024-05550-2…
  6 April 2024 12:00 – Nitin Narayan Rao

• Relationship between the natural cessation time of umbilical cord pulsation in full-term newborns delivered vaginally and maternal-neonatal outcomes: a prospective cohort study

  BMC Pregnancy Childbirth. 2024 Apr 4;24(1):236. doi: 10.1186/s12884-024-06444-9.ABSTRACTBACKGROUND: To analyze the impact of the time of natural cessation of the umbilical cord on maternal and infant outcomes in order to explore the time of clamping that would be beneficial to maternal and infant outcomes.METHODS: The study was a cohort study and pregnant women who met the inclusion and exclusion criteria at the Obstetrics and Gynecology Department of Qilu Hospital of Shandong University from September 2020 to September 2021. Analysis using Kruskal-Wallis rank sum test, Pearson's Chi-squared test, generalized linear mixed model (GLMM) and repeated measures ANOVA. If the difference between groups was statistically significant, the Bonferroni test was then performed. A two-sided test of P < 0.05 was considered statistically significant.RESULTS: A total of 345 pregnants were included in this study. The subjects were divided into the ≤60 seconds group (n = 134), the 61-89 seconds group (n = 106) and the ≥90 seconds group (n = 105) according to the time of natural arrest of the umbilical cord. There was no statistically significant difference in the amount of postpartum hemorrhage and the need for iron, medication, or supplements in the postpartum period between the different cord spontaneous arrest time groups for mothers (P > 0.05). The weight of the newborns in the three groups was (3316.27 ± 356.70) g, (3387.26 ± 379.20) g, and (3455.52 ± 363.78) g, respectively, and the number of days of cord detachment was 12.00 (8.00, 15.75) days, 10.00 (7.00, 15.00) days and 9.00 (7.00, 13.00) days, respectively, as the time of natural cessation of the cord increased. The neonatal lymphocyte ratio, erythrocyte pressure, and hemoglobin reached a maximum in the 61-89 s group at (7.41 ± 2.16) %, (61.77 ± 8.17) % and (194.52 ± 25.84) g/L, respectively. Lower incidence of neonatal hyperbilirubinemia in the 61-89 s group compared to the ≥90s group 0 vs 4.8 (P < 0.05).CONCLUSIONS: In full-term singleton vaginal births, maternal and infant outcomes are better when waiting for 61-89 s after birth for the cord to stop pulsating naturally, suggesting that we can wait up to 90s for the cord to stop pulsating naturally, and if the cord does not stop pulsating after 90s, artificial weaning may be more beneficial to maternal and infant outcomes.PMID:38575874 | PMC:PMC10993427 | DOI:10.1186/s12884-024-06444-9…
  4 April 2024 12:00 – Ruijie Wu

• A cross-sectional survey of delivery room transitional care management for very/extremely preterm infants in 24 hospitals in Shenzhen City

  Zhongguo Dang Dai Er Ke Za Zhi. 2024 Mar 15;26(3):250-257. doi: 10.7499/j.issn.1008-8830.2308017.ABSTRACTOBJECTIVES: To investigate the current status of delivery room transitional care management for very/extremely preterm infants in Shenzhen City.METHODS: A cross-sectional survey was conducted in November 2022, involving 24 tertiary hospitals participating in the Shenzhen Neonatal Data Network. The survey assessed the implementation of transitional care management in the delivery room, including prenatal preparation, delivery room resuscitation, and post-resuscitation management in the neonatal intensive care unit. Very/extremely preterm infants were divided into four groups based on gestational age: <26 weeks, 26-28+6 weeks, 29-30+6 weeks, and 31-31+6 weeks. Descriptive analysis was performed on the results.RESULTS: A total of 140 very/extremely preterm infants were included, with 10 cases in the <26 weeks group, 45 cases in the 26-28+6 weeks group, 49 cases in the 29-30+6 weeks group, and 36 cases in the 31-31+6 weeks group. Among these infants, 99 (70.7%) received prenatal counseling, predominantly provided by obstetricians (79.8%). The main personnel involved in resuscitation during delivery were midwives (96.4%) and neonatal resident physicians (62.1%). Delayed cord clamping was performed in 52 cases (37.1%), with an average delay time of (45±17) seconds. Postnatal radiant warmer was used in 137 cases (97.9%) for thermoregulation. Positive pressure ventilation was required in 110 cases (78.6%), with 67 cases (60.9%) using T-piece resuscitators and 42 cases (38.2%) using a blended oxygen device. Blood oxygen saturation was monitored during resuscitation in 119 cases (85.0%). The median time from initiating transitional care measures to closing the incubator door was 87 minutes.CONCLUSIONS: The implementation of delivery room transitional care management for very/extremely preterm infants in the hospitals participating in the Shenzhen Neonatal Data Network shows varying degrees of deviation from the corresponding expert consensus in China. It is necessary to bridge the gap through continuous quality improvement and multicenter collaboration to improve the quality of the transitional care management and outcomes in very/extremely preterm infants.PMID:38557376 | PMC:PMC10986374 | DOI:10.7499/j.issn.1008-8830.2308017…
  1 April 2024 12:00 – Shenzhen Neonatal Data Network

• Multicentre, randomised controlled trial of physiological-based cord clamping versus immediate cord clamping in infants with a congenital diaphragmatic hernia (PinC): statistical analysis plan

  Trials. 2024 Mar 20;25(1):198. doi: 10.1186/s13063-024-08027-7.ABSTRACTBACKGROUND: Infants born with congenital diaphragmatic hernia (CDH) are at high risk of respiratory insufficiency and pulmonary hypertension. Routine practice includes immediate clamping of the umbilical cord and endotracheal intubation. Experimental animal studies suggest that clamping the umbilical cord guided by physiological changes and after the lungs have been aerated, named physiological-based cord clamping (PBCC), could enhance the fetal-to-neonatal transition in CDH. We describe the statistical analysis plan for the clinical trial evaluating the effects of PBCC versus immediate cord clamping on pulmonary hypertension in infants with CDH (PinC trial).DESIGN: The PinC trial is a multicentre, randomised controlled trial in infants with isolated left-sided CDH, born ≥ 35.0 weeks of gestation. The primary outcome is the incidence of pulmonary hypertension in the first 24 h after birth. Maternal outcomes include estimated maternal blood loss. Neonatal secondary outcomes include mortality before discharge, extracorporeal membrane oxygenation therapy, and number of days of mechanical ventilation. Infants are 1:1 randomised to either PBCC or immediate cord clamping using variable random permutated block sizes (4-8), stratified by treatment centre and estimated severity of pulmonary hypoplasia (i.e. mild/moderate/severe). At least 140 infants are needed to detect a relative reduction in pulmonary hypertension by one third, with 80% power and 0.05 significance level. A chi-square test will be used to evaluate the hypothesis that PBCC decreases the occurrence of pulmonary hypertension. This plan is written and submitted without knowledge of the collected data. The trial has been ethically approved.TRIAL REGISTRATION: ClinicalTrials.gov NCT04373902 (registered April 2020).PMID:38509614 | PMC:PMC10953116 | DOI:10.1186/s13063-024-08027-7…
  21 March 2024 11:00 – Emily J J Horn-Oudshoorn

• Third stage of labor: evidence-based practice for prevention of adverse maternal and neonatal outcomes

  Am J Obstet Gynecol. 2024 Mar;230(3S):S1046-S1060.e1. doi: 10.1016/j.ajog.2022.11.1298. Epub 2023 Aug 21.ABSTRACTThe third stage of labor is defined as the time period between delivery of the fetus through delivery of the placenta. During a normal third stage, uterine contractions lead to separation and expulsion of the placenta from the uterus. Postpartum hemorrhage is a relatively common complication of the third stage of labor. Strategies have been studied to mitigate the risk of postpartum hemorrhage, leading to the widespread implementation of active management of the third stage of labor. Initially, active management of the third stage of labor consisted of a bundle of interventions including administration of a uterotonic agent, early cord clamping, controlled cord traction, and external uterine massage. However, the effectiveness of these interventions as a bundle has been questioned, leading to abandonment of some components in recent years. Despite this, upon review of selected international guidelines, we found that the term "active management of the third stage of labor" was still used, but recommendations for and against individual interventions were variable and not necessarily supported by current evidence. In this review, we: (1) examine the physiology of the third stage of labor, (2) present evidence related to interventions that prevent postpartum hemorrhage and promote maternal and neonatal health, (3) review current global guidelines and recommendations for practice, and (4) propose future areas of investigation. The interventions in this review include pharmacologic agents to prevent postpartum hemorrhage, cord clamping, cord milking, cord traction, cord drainage, early skin-to-skin contact, and nipple stimulation. Treatment of complications of the third stage of labor is outside of the scope of this review. We conclude that current evidence supports the use of effective pharmacologic postpartum hemorrhage prophylaxis, delayed cord clamping, early skin-to-skin contact, and controlled cord traction at delivery when feasible. The most effective uterotonic regimens for preventing postpartum hemorrhage after vaginal delivery include oxytocin plus ergometrine; oxytocin plus misoprostol; or carbetocin. After cesarean delivery, carbetocin or oxytocin as a bolus are the most effective regimens. There is inconsistent evidence regarding the use of tranexamic acid in addition to a uterotonic compared with a uterotonic alone for postpartum hemorrhage prevention after all deliveries. Because of differences in patient comorbidities, costs, and availability of resources and staff, decisions to use specific prevention strategies are dependent on patient- and system-level factors. We recommend that the term "active management of the third stage of labor" as a combined intervention no longer be used. Instead, we recommend that "third stage care" be adopted, which promotes the implementation of evidence-based interventions that incorporate practices that are safe and beneficial for both the woman and neonate.PMID:38462248 | DOI:10.1016/j.ajog.2022.11.1298…
  10 March 2024 11:00 – Alyssa R Hersh

• Impact of the Timing of Umbilical Cord Clamping on Maternal and Neonatal Outcomes in Saudi Arabia

  Cureus. 2024 Feb 4;16(2):e53536. doi: 10.7759/cureus.53536. eCollection 2024 Feb.ABSTRACTINTRODUCTION: The optimal time for umbilical cord clamping after delivery has been under debate for several decades. This study aimed to assess the time-dependent effects of umbilical cord clamping on maternal and neonatal outcomes.METHODS: An observational correlational design was used to recruit 161 pregnant women conveniently. Outcomes were observed and recorded using a structured checklist developed by the authors. Pregnant females aged ≥18 years, with uncomplicated delivery, and who were willing to participate were recruited. Exclusion criteria included stillbirths, newborns with congenital anomalies, newborns too small for their gestational age, intra-uterine growth restriction, nuchal cord, and meconium-stained liquor.RESULTS: The mean age of the participants was 29.93 ± 6 years. Early clamping (<1 minute) was performed for 93.8% of the participants with a mean of 29.58 ± 18 seconds. Delayed clamping was associated with a decrease in blood loss and the length of hospital stay in addition to an increase in first-minute APGAR score and neonatal temperature (P < 0.05).CONCLUSIONS: Delayed cord clamping was associated with improved maternal and neonatal outcomes.PMID:38445130 | PMC:PMC10912892 | DOI:10.7759/cureus.53536…
  6 March 2024 12:00 – Bayan Sonbol

• Physiological-based cord clamping in very preterm infants: the Aeration, Breathing, Clamping 3 (ABC3) trial-statistical analysis plan for a multicenter randomized controlled trial

  Trials. 2024 Mar 4;25(1):164. doi: 10.1186/s13063-024-08014-y.ABSTRACTBACKGROUND: Mortality, cerebral injury, and necrotizing enterocolitis (NEC) are common complications of very preterm birth. An important risk factor for these complications is hemodynamic instability. Pre-clinical studies suggest that the timing of umbilical cord clamping affects hemodynamic stability during transition. Standard care is time-based cord clamping (TBCC), with clamping irrespective of lung aeration. It is unknown whether delaying cord clamping until lung aeration and ventilation have been established (physiological-based cord clamping, PBCC) is more beneficial. This document describes the statistical analyses for the ABC3 trial, which aims to assess the efficacy and safety of PBCC, compared to TBCC.METHODS: The ABC3 trial is a multicenter, randomized trial investigating PBCC (intervention) versus TBCC (control) in very preterm infants. The trial is ethically approved. Preterm infants born before 30 weeks of gestation are randomized after parental informed consent. The primary outcome is intact survival, defined as the composite of survival without major cerebral injury and/or NEC. Secondary short-term outcomes are co-morbidities and adverse events assessed during NICU admission, parental reported outcomes, and long-term neurodevelopmental outcomes assessed at a corrected age of 2 years. To test the hypothesis that PBCC increases intact survival, a logistic regression model will be estimated using generalized estimating equations (accounting for correlation between siblings and observations in the same center) with treatment and gestational age as predictors. This plan is written and submitted without knowledge of the data.DISCUSSION: The findings of this trial will provide evidence for future clinical guidelines on optimal cord clamping management at birth.TRIAL REGISTRATION: ClinicalTrials.gov NCT03808051. Registered on 17 January 2019.PMID:38439024 | PMC:PMC10913647 | DOI:10.1186/s13063-024-08014-y…
  4 March 2024 12:00 – Sten P Willemsen

• Caffeine pharmacokinetics following umbilical vein injection during delayed cord clamping in preterm lambs

  Pediatr Res. 2024 Mar 1. doi: 10.1038/s41390-024-03117-3. Online ahead of print.ABSTRACTBACKGROUND: Spontaneous breathing during and after delayed cord clamping (DCC) stabilizes cardiopulmonary transition at birth. Caffeine stimulates breathing and decreases apnea in premature newborns. We evaluated the pharmacokinetics and physiological effects of early caffeine administration-direct injection into the umbilical vein (UV) during DCC or administered through a UV catheter (UVC) after delivery.METHODS: Eighteen extremely premature lambs (125-127d, term gestation 145d) were exteriorized and instrumented. Lambs received caffeine-citrate at high (40 mg/kg) or standard-dose (20 mg/kg) via direct UV (DUV) injection during DCC, or via the UVC.RESULTS: Mean peak plasma caffeine concentrations were lower with high-dose DUV compared to UVC (18 ± 4.3 vs. 46 ± 12 mg/L, p < 0.05). With standard-dose caffeine, mean peak plasma levels were 7.48 ± 2.6 with DUV and 28.73 ± 9.4 mg/L with UVC. The volume of distribution was higher in the DUV group compared to UVC (2.5 ± 1.0 vs. 0.69 ± 0.15 L/kg) with an estimated 39 ± 18% entering the maternal circulation. Maternal peak concentrations were 0.79 ± 0.71 and 1.43 ± 0.74 mg/L with standard and high-dose DUV, respectively.CONCLUSIONS: Caffeine injected directly into the UV during DCC is feasible but achieves lower concentrations due to high volume of distribution including maternal circulation. Further trials evaluating DUV caffeine injection should use higher caffeine doses.IMPACT: Respiratory stimulation with early caffeine may reduce the need for intubation in preterm infants. In the preterm lambs, caffeine injection directly into the umbilical vein during delayed cord clamping is feasible. Plasma caffeine concentrations are less than half when administered directly into the umbilical vein during delayed cord clamping compared to administration via an umbilical venous catheter following birth likely attributed to a larger volume of distribution or injection site leak. There were no significant hemodynamic alterations following caffeine injection.PMID:38429570 | DOI:10.1038/s41390-024-03117-3…
  1 March 2024 12:00 – Lida Zeinali

• Deferred cord clamping to improve neonatal blood values: A systematic review and meta-analysis

  Int J Nurs Stud. 2024 May;153:104718. doi: 10.1016/j.ijnurstu.2024.104718. Epub 2024 Feb 9.ABSTRACTBACKGROUND: Practices related to umbilical cord clamping at birth should be evidence-based. Deferred cord clamping, compared to immediate cord clamping, shows benefits for preterm neonates but this may also apply to healthy term neonates. Different blood sampling techniques are used to measure effect of deferred and immediate cord clamping.OBJECTIVE: To assess the statistical and effect size differences between blood biomarkers from umbilical cord and capillary blood samples of healthy term neonates following either immediate or deferred cord clamping.DESIGN: Systematic review and meta-analysis.METHODS: The databases PubMed, Medline, CENTRAL, CINAHL and EMBASE were systematically searched. We included studies with a randomised clinical trial design comparing deferred and immediate cord clamping among healthy term neonates born by a spontaneous vaginal birth, reporting on blood biomarkers. Studies including caesarean births and premature births/neonates were excluded. Study attributes, sampling technique, blood biomarkers, mean differences, and standard deviations were extracted. The standardised mean differences (SMD) and sampling errors were calculated for effect size estimation. Meta-analyses were performed if ≥2 studies reported the same outcome using RevMan 5. Subgroup analyses distinguished effects from umbilical cord and capillary blood samples. Moderator tests and publication bias analyses were performed using JASP.RESULTS: Fifteen studies were included for analysis. The biomarkers haematocrit, haemoglobin, and bilirubin were reported in ≥2 studies and thus eligible for pooling. No differences were found in haemoglobin (SMD -0.04, 95%CI -0.57 to 0.49) or bilirubin values (SMD 0.13, 95%CI -0.03 to 0.28) between umbilical cord blood samples collected after deferred or immediate cord clamping. Deferred cord clamping led to lower haematocrit values (SMD -0.3, 95%CI -0.53 to -0.07). Higher haematocrit (SMD 0.67, 95%CI 0.37 to 0.97) and haemoglobin values (SMD 0.76, 95%CI 0.56 to 0.97) from capillary blood samples, collected 2 to 72 h postpartum, showed when cord clamping was deferred. No effect was found on bilirubin values (SMD 0.13, 95%CI -0.03 to 0.28) irrespective of the sampling technique.CONCLUSIONS: Blood collected after deferred umbilical cord clamping showed increased haemoglobin and haematocrit values up to 72 h after birth, opposed to bilirubin values. Clinical evaluation of blood biomarkers from the umbilical cord shows different values compared to capillary blood. Sampling time and technique therefore seem essential in estimating the effects of deferred cord clamping.TWEETABLE ABSTRACT: This meta-analysis shows that sampling time and technique are essential in estimating the effects of deferred cord clamping on neonatal blood values.PMID:38417349 | DOI:10.1016/j.ijnurstu.2024.104718…
  28 February 2024 12:00 – Charifa Zemouri

• Process and Outcome Measures for Infants Born Moderate and Late Preterm in Tertiary Canadian Neonatal Intensive Care Units

  J Pediatr. 2024 Jun;269:113976. doi: 10.1016/j.jpeds.2024.113976. Epub 2024 Feb 23.ABSTRACTOBJECTIVE: To describe the prevalence of and between-center variations in care practices and clinical outcomes of moderate and late preterm infants (MLPIs) admitted to tertiary Canadian neonatal intensive care units (NICUs).STUDY DESIGN: This was a retrospective cohort study including infants born at 320/7 through 366/7 weeks of gestation and admitted to 25 NICUs participating in the Canadian Neonatal Network between 2015 and 2020. Patient characteristics, process measures represented by care practices, and outcome measures represented by clinical in-hospital and discharge outcomes were reported by gestational age weeks. NICUs were compared using indirect standardization after adjustment for patient characteristics.RESULTS: Among 25 669 infants (17% of MLPIs born in Canada during the study period) included, 45% received deferred cord clamping, 7% had admission hypothermia, 47% received noninvasive respiratory support, 11% received mechanical ventilation, 8% received surfactant, 40% received antibiotics in the first 3 days, 4% did not receive feeding in the first 2 days, and 77% had vascular access. Mortality, early-onset sepsis, late-onset sepsis, or necrotizing enterocolitis occurred in <1% of the study cohort. Median (IQR) length of stay was 14 (9-21) days among infants discharged home from the admission hospital and 5 (3-9) days among infants transferred to community hospitals. Among infants discharged home, 33% were discharged on exclusive breastmilk and 75% on any breastmilk. There were significant variations between NICUs in all process and outcome measures.CONCLUSIONS: Care practices and outcomes of MLPIs varied significantly between Canadian NICUs. Standardization of process and outcome quality measures for this population will enable benchmarking and research, facilitating systemwide improvements.PMID:38401787 | DOI:10.1016/j.jpeds.2024.113976…
  24 February 2024 12:00 – Ayman Abou Mehrem

• Physiological-based cord clamping stabilised cardiorespiratory parameters in very low birth weight infants

  Acta Paediatr. 2024 May;113(5):931-938. doi: 10.1111/apa.17135. Epub 2024 Jan 31.ABSTRACTAIM: We investigated the influence of physiological-based cord clamping (PBCC) on cardiorespiratory stability in very low birth weight (VLBW) infants during the first 72 h of life.METHODS: This retrospective study comprised VLBW infants born at <32 + 0 weeks of gestation and admitted to the neonatal intensive care unit of the Medical University of Graz, Austria, from December 2014 to April 2021. VLBW infants delivered with PBCC were matched by gestational age and birth weight to delayed cord clamping controls. The PBCC group was stabilised after birth with an intact cord. Routine monitoring parameters were compared between the groups.RESULTS: We included 54 VLBW infants. The mean gestational ages of the PBCC group and controls were 27.4 ± 1.9 versus 27.4 ± 1.8 weeks (p = 0.87), and the mean birth weights were 912 ± 288 versus 915 ± 285 g (p = 0.96), respectively. The mean cord clamping time was 191 ± 78 s in the PBCC group. Heart rate was lower in the PBCC group during the first 3 days after birth, reaching significance by 10 h. Other monitoring parameters did not reveal any differences between the two groups.CONCLUSION: PBCC stabilised cardiorespiratory parameters in VLBW infants. The lower heart rate in the PBCC group suggested higher blood volume following intact cord resuscitation.PMID:38293717 | DOI:10.1111/apa.17135…
  31 January 2024 12:00 – Nina Hoeller

• Reference Ranges for Regional Cerebral Oxygen Saturation with Masimo O3® after Birth and Differences with Other Devices

  Am J Perinatol. 2024 Feb 27. doi: 10.1055/a-2253-8740. Online ahead of print.ABSTRACTOBJECTIVE: Cerebral oximetry using near-infrared spectroscopy (NIRS) is a noninvasive optical technology widely used in neonatology. The present study aimed to define reference ranges for cerebral tissue oxygen saturation (crSO2) with a new four-wavelength NIRS device, Masimo O3® oximeter, during immediate transition after birth and compare values with those obtained previously with NIRO 200NX®.STUDY DESIGN: This was a prospective observational study using Masimo O3 device to measure crSO2 and regional cerebral fractional tissue oxygen extraction (cFTOE) in healthy term newborns delivered by primary cesarean section, during the 15 minutes after cord clamping. The neonates who required any medical support were excluded. The NIRS sensor was placed on the right forehead. Peripheral oxygen saturation and heart rate were continuously measured by pulse oximetry. Previous studies which established centiles for crSO2 with NIRO 200NX were used for comparison.RESULTS: A total of 44 newborns were included. The median crSO2 and cFTOE (interquartile range) at 2, 5, and 7 minutes was 54% (49-54), 71% (64-86), and 79% (73-84) and 0,25 (0,18-0,33), 0,19 (0,15-0,23), and 0,16 (0,12-0,21), respectively, with no further changes afterwards. The crSO2 measurements were significantly higher with Masimo O3 compared with NIRO-200NX.CONCLUSION: The present observational study presented reference ranges for crSO2 and cFTOE measured with Masimo O3 oximeter during the immediate neonatal transition. Values obtained with O3 were higher than those obtained with other oximeters. For this reason, crSO2 is device-specific so there must be known reference values for each oximeter to define therapeutic interventions based on crSO2 and assess cerebral oxygenation in clinical studies.KEY POINTS: · Masimo O3 uses four wavelengths to measure regional oxygen saturation value.. · O3 values of crSO2 and cFTOE differ with other neonatal oximeters at birth.. · Knowledge of reference range of O3 at birth is essential to guide resuscitation..PMID:38272062 | DOI:10.1055/a-2253-8740…
  25 January 2024 12:00 – Luis Bachiller Carnicero

• Interpretation of 2023 American Heart Association and American Academy of Pediatrics focused update on neonatal resuscitation guidelines

  Zhongguo Dang Dai Er Ke Za Zhi. 2024 Jan 15;26(1):25-30. doi: 10.7499/j.issn.1008-8830.2311107.ABSTRACTIn November 2023, the American Heart Association and the American Academy of Pediatrics jointly released key updates to the neonatal resuscitation guidelines based on new clinical evidence. This update serves as an important supplement to the "Neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care". The aim of this paper is to outline the key updates and provide guidance on umbilical cord management and the selection of positive pressure ventilation equipment and its additional interfaces in neonatal resuscitation.PMID:38269455 | PMC:PMC10817739 | DOI:10.7499/j.issn.1008-8830.2311107…
  25 January 2024 12:00 – Tian Zhu

• Effective and simple interventions to improve outcomes for preterm infants worldwide: The FIGO PremPrep-5 initiative

  Int J Gynaecol Obstet. 2024 Jun;165(3):929-935. doi: 10.1002/ijgo.15269. Epub 2024 Jan 24.ABSTRACTPreterm birth remains the leading cause of mortality among under-5's and is a major contributor to the reduction in quality-of-life adjusted years and reduction in human capital. Globally, there are many interventions and care bundles that aim to reduce the impact of preterm birth once preterm labor has ensued and into the neonatal period; not all of these are applicable in all settings. Here, we introduce the FIGO PremPrep-5 initiative, which aims to disseminate key information on the most simple and effective interventions with the aim of increasing implementation globally. Before delivery, we recommend a course of antenatal corticosteroids, and intrapartum magnesium sulfate. At delivery, we recommend delayed cord clamping. Postnatally, we recommend early feeding with breast milk and immediate kangaroo care. While there are many other interventions that may improve outcomes at the time of labor and after preterm birth, these are clinically effective and relatively inexpensive options that can be practiced in most settings and supplemented with more advanced care. We include examples of a training video and infographics that will be used for dissemination.PMID:38264849 | DOI:10.1002/ijgo.15269…
  24 January 2024 12:00 – Megan Hall

• Thermoregulation for very preterm infants in the delivery room: a narrative review

  Pediatr Res. 2024 May;95(6):1448-1454. doi: 10.1038/s41390-023-02902-w. Epub 2024 Jan 22.ABSTRACTAbnormal temperature in preterm infants is associated with increased morbidity and mortality. Infants born prematurely are at risk of abnormal temperature immediately after birth in the delivery room (DR). The World Health Organization (WHO) recommends that the temperature of newly born infants is maintained between 36.5-37.5oC after birth. When caring for very preterm infants, the International Liaison Committee on Resuscitation (ILCOR) recommends using a combination of interventions to prevent heat loss. While hypothermia remains prevalent, efforts to prevent it have increased the incidence of hyperthermia, which may also be harmful. Delayed cord clamping (DCC) for preterm infants has been recommended by ILCOR since 2015. Little is known about the effect of timing of DCC on temperature, nor have there been specific recommendations for thermal care before DCC. This review article focuses on the current evidence and recommendations for thermal care in the DR, and considers thermoregulation in the context of emerging interventions and future research directions. IMPACT: Abnormal temperature is common amongst very preterm infants after birth, and is an independent risk factor for mortality. The current guidelines recommend a combination of interventions to prevent heat loss after birth. Despite this, abnormal temperature is still a problem, across all climates and economies. New and emerging delivery room practice (i.e., delayed cord clamping, mobile resuscitation trolleys, early skin to skin care) may have an effect on infant temperature. This article reviews the current evidence and recommendations, and considers future research directions.PMID:38253875 | PMC:PMC11126394 | DOI:10.1038/s41390-023-02902-w…
  22 January 2024 12:00 – Emma A Dunne

• Comparing two different placental transfusion strategies for very preterm infants at birth: a matched-pairs study

  Ann Med. 2023;55(2):2301589. doi: 10.1080/07853890.2023.2301589. Epub 2024 Jan 19.ABSTRACTOBJECTIVE: To evaluate the clinical outcomes of using the extra-uterine placental transfusion (EPT) approach in very preterm infants (VPIs, gestational age <32 weeks) and compare this to delayed cord clamping (DCC) after birth.METHODS: In this matched pairs study, we compared the clinical outcomes of the EPT group to those of the DCC group. EPT were performed in fifty-three VPIs, of whom 27 were singletons and 25 were twins. The singleton VPIs were matched for gestational age (±5 days) and delivery mode, and the twin VPIs were matched between each other with the first twin subjected to DCC and the second twin to EPT. Data on the infants were collected and analysed as an overall group. A twin subgroup consisting of DCC and EPT groups was also analysed separately. The primary study outcome was either death or major morbidities.RESULTS: In total, 100 infants were included (n = 50 EPT group, n = 50 DCC group). The gestational ages of the DCC and EPT groups were (29.16 ± 1.76) and (29.12 ± 1.84) weeks, respectively. There were no differences in either deaths or major morbidities and other clinical outcomes, including the resuscitation variables, haemoglobin levels and red blood cell transfusion, between the two groups. In twin subgroups (gestational age 29.05 ± 1.89 weeks), EPT was associated with a higher rate of necrotizing enterocolitis (NEC) when compared with DCC (odds ratio = 7 (95% CI, 1.06 to 56.89), p = 0.031).CONCLUSIONS: In twin subgroups, the incidence of NEC was higher in the EPT group when compared to the DCC group and therefore based on an abundance of caution the use of EPT in very preterm twins is not recommended.PMID:38242076 | PMC:PMC10802796 | DOI:10.1080/07853890.2023.2301589…
  19 January 2024 12:00 – Yan Wu

• Delayed cord clamping vs cord milking in elective cesarean delivery at term: a randomized controlled trial

  Am J Obstet Gynecol MFM. 2024 Mar;6(3):101279. doi: 10.1016/j.ajogmf.2024.101279. Epub 2024 Jan 15.ABSTRACTBACKGROUND: Delayed cord clamping has significant beneficial effects on the neonate and its transition to extrauterine life and, therefore, is common practice at vaginal births in the Netherlands. In 2015, 16% of neonates were born via cesarean delivery; moreover, in 81% of these cases, the umbilical cord was clamped and cut immediately. Neonatal benefits of delayed cord clamping are an increased circulating volume of 25 to 30 mL/kg, leading to a higher preload of both the right and left ventricles during the transition from umbilical circulation to pulmonary circulation, thus maintaining a stable left ventricle output, and to higher neonatal hemoglobin and hematocrit levels 24 to 48 hours after birth. Currently, little is known about whether the abovementioned neonatal benefits of delayed cord clamping could apply to neonates delivered by cesarean delivery. In these cases, possible negative effects on neonatal outcomes (ie, neonatal hypothermia, lower Apgar scores, and hyperbilirubinemia) and maternal outcomes (ie, increased maternal blood loss and higher postoperative infection rate) should also be taken into consideration.OBJECTIVE: This study aimed to determine whether clamping the umbilical cord after 2 minutes is superior to cord milking during elective cesarean deliveries at term, taking both short- and long-term neonatal and maternal outcomes into consideration, and to determine whether cord milking could be an appropriate alternative to delayed cord clamping.STUDY DESIGN: A randomized controlled trial was conducted in a large secondary care center in the Netherlands (Amphia Hospital in Breda) from October 2020 to April 2022. A total of 115 patients who underwent an elective cesarean delivery between 37 0/7 and 41 6/7 weeks of gestation were included. The primary outcomes were neonatal hemoglobin and hematocrit levels at 48 hours after birth. The secondary outcomes were divided into neonatal and maternal outcomes.RESULTS: After randomization, 58 participants were treated with cord milking, and 57 participants were treated with delayed cord clamping. There was no significant difference in demographic characteristics between both groups. There was no significant difference in the primary outcomes, with a mean hemoglobin level 48 hours after birth of 12.1 mmol/L in the delayed cord clamping group and 12.2 mmol/L in the cord milking group (P=.80). Regarding our secondary outcomes, there was no significant difference regarding Apgar score, neonatal body temperature, maternal blood loss, and postoperative infection rate between our intervention groups.CONCLUSION: Hemoglobin and hematocrit levels at 48 hours after birth showed no significant difference when comparing delayed cord clamping with cord milking. Delayed cord clamping did not lead to increased maternal blood loss or postoperative infections compared with a method with a much shorter timeframe between delivery and clamping of the umbilical cord, namely, cord milking. In addition, delayed cord clamping did not lead to a lower Apgar score or neonatal temperature compared with cord milking. Our research suggests that delayed cord clamping can be safely performed during elective cesarean deliveries at term. If intraoperative circumstances do not allow for delayed cord clamping, cord milking can be an appropriate alternative for the neonate at term.PMID:38232817 | DOI:10.1016/j.ajogmf.2024.101279…
  17 January 2024 12:00 – Stéphanie M I de Preud'homme d'Hailly de Nieuport

• Does the birth plan match what is relevant to women? Preferences of Spanish women when giving birth

  BMC Womens Health. 2024 Jan 15;24(1):42. doi: 10.1186/s12905-023-02856-5.ABSTRACTBACKGROUND: To support women in making shared decisions, it is important to know what is relevant to them. The aim is to explore which of the options included in birth plans (BP) are of most interest to women, and which are more controversial. In addition, the possible association of this variability with personal characteristics.METHODS: The data are part of a cross-sectional descriptive study, carried out in xxx, on the clinimetric characteristics of two instruments to measure women's needs in labour and postpartum. Women were recruited consecutively by their midwives during pregnancy check-ups, receive a link to a digital questionnaire and were allowed to provide links to the questionnaires to other pregnant women. Women were asked to determine their level of agreement with statements about the birth environment, accompaniment, pain relief, medical intervention and neonatal care. The relationship between agreement with each statement, socio-demographic variables and fear of childbirth (W-DEQ-A) was analysed using a combination of descriptive statistics to analyse frequencies, and regression models to test the effect of socio-demographic variables and fear of childbirth on those items with the greatest variability.RESULTS: Two hundred forty-seven women responded. More than 90% preferred a hospital delivery, with information about and control over medical intervention, accompanied by their partner and continuous skin-to-skin contact with the newborn. There are other questions to which women attach less importance or which show greater variability, related to more clinical aspects, like foetal monitoring, placenta delivery, or cord clamping… Various factors are related to this variability; parity, nationality, educational level, risk factor or fear of childbirth are the most important.CONCLUSIONS: Some items referring to the need for information and participation are practically unanimous among women, while other items on technical interventions generate greater variability. That should make us think about which ones require a decision after information and which ones should be included directly. The choice of more interventional deliveries is strongly associated with fear of childbirth.PMID:38225596 | PMC:PMC10789003 | DOI:10.1186/s12905-023-02856-5…
  15 January 2024 12:00 – Isabel Artieta-Pinedo

• Polyethylene bags before cord clamping in very preterm infants: a randomised controlled trial

  Arch Dis Child Fetal Neonatal Ed. 2024 Apr 18;109(3):317-321. doi: 10.1136/archdischild-2023-325808.ABSTRACTOBJECTIVE: Hypothermia on admission to the neonatal intensive care unit (NICU) is associated with an increased risk of death in preterm infants. There are currently no evidence-based recommendations for thermal care before cord clamping (CC). We wished to determine whether placing very preterm infants in a polyethylene bag (PB) before CC, compared with after CC, results in more infants with a temperature in the normal range on NICU admission.DESIGN: Randomised controlled trial.SETTING: Tertiary maternity hospital.PATIENTS: Inborn infants<32 weeks' gestational age (GA).INTERVENTIONS: Infants were randomly assigned to have a PB placed before or after CC.MAIN OUTCOME: Rectal temperature within the normal range (36.5°C-37.5°C) on NICU admission.RESULTS: Between July 2020 and September 2022, 198/220 (90%) eligible infants were enrolled in this study; 99 (44 (44%) girls) were randomly assigned to BEFORE and 99 (53 (54%) girls) to AFTER. Median (IQR) GA 29 (27-31) vs 29 (27-31) weeks, mean (SD) birth weight 1206 (429) vs 1138 (419) g, respectively. The proportion of infants who had normal temperature on NICU admission did not differ between the groups (BEFORE 54/99 (55%) vs AFTER 55/98 (56%), p 0.824). The proportion of infants with a temperature outside of the normal range was similar between the groups; hypothermia (BEFORE 34/99 (34%) vs AFTER 33/98 (34%), hyperthermia (BEFORE 10/99 (10%) vs AFTER 10/98 (10%)).CONCLUSIONS: Placing a PB before CC did not increase the proportion of preterm infants with normal temperature on NICU admission. A large proportion of preterm infants had abnormal temperature. Further studies on thermoregulation before CC are needed.TRIAL REGISTRATION NUMBER: NCT04463511.PMID:38212105 | PMC:PMC11041611 | DOI:10.1136/archdischild-2023-325808…
  11 January 2024 12:00 – Emma A Dunne

• Application of desirability of outcome ranking to the milking in non-vigorous infants trial

  Early Hum Dev. 2024 Feb;189:105928. doi: 10.1016/j.earlhumdev.2023.105928. Epub 2024 Jan 5.ABSTRACTOBJECTIVES: Neonatal trials have traditionally used binary composite short-term (such as death or bronchopulmonary dysplasia) or longer-term (such as death or severe neurodevelopmental impairment) outcomes. We applied the Desirability Of Outcome Ranking (DOOR) method to rank the overall patient outcome by best (no morbidities) to worst (death).STUDY DESIGN: Using a completed large multicenter trial (Milking In Non-Vigorous Infants [MINVI]) of umbilical cord milking (UCM) vs. early cord clamping (ECC), we applied the DOOR methodology to neonatal outcomes. Six outcomes were chosen and ranked: no interventions or NICU admission (most desirable); received initial cardiorespiratory support at birth; neonatal intensive care unit (NICU) admission for predefined criteria; mild hypoxic-ischemic encephalopathy (HIE); moderate to severe HIE; and death (least desirable).RESULTS: 1524 non-vigorous newborns born between 35 and 42 weeks' gestation had data for analysis. The DOOR distribution was different between the UCM and ECC arms, with a significantly greater probability (55.8 % [95 % CI 53.1-58.5 %; p < 0.0001]) of a randomly selected neonate having a more desirable outcome if they were in the UCM arm. DOOR probabilities of averting individual adverse outcomes such as NICU admission for predefined criteria (52.8 %; 95%CI 50.5-55.1 %) and cardiorespiratory support (54.0 %; 95%CI 51.6-56.4 %) were significantly higher among those in the UCM group.CONCLUSION: DOOR provides an overall assessment of the benefits and harms with greater insight than typical binary composite measures to clinicians and parents when evaluating an intervention. Future neonatal trials should consider the a priori use of the DOOR methodology to evaluate trial outcomes.PMID:38211436 | PMC:PMC10922970 | DOI:10.1016/j.earlhumdev.2023.105928…
  11 January 2024 12:00 – Anup C Katheria

• The Delivery Room Resuscitation of Infants with Congenital Diaphragmatic Hernia Treated with Fetoscopic Endoluminal Tracheal Occlusion: Beyond the Balloon

  Fetal Diagn Ther. 2024;51(2):184-190. doi: 10.1159/000536209. Epub 2024 Jan 10.ABSTRACTINTRODUCTION: Randomized controlled trials found that fetoscopic endoluminal tracheal occlusion (FETO) resulted in increased fetal lung volume and improved survival for infants with isolated, severe left-sided congenital diaphragmatic hernia (CDH). The delivery room resuscitation of these infants is particularly unique, and the specific delivery room events are largely unknown. The objective of this study was to compare the delivery room resuscitation of infants treated with FETO to standard of care (SOC) and describe lessons learned.METHODS: Retrospective single-center cohort study of infants treated with FETO compared to infants who met FETO criteria during the same period but who received SOC.RESULTS: FETO infants were more likely to be born prematurely with 8/12 infants born &lt;35 weeks gestational age compared to 3/35 SOC infants. There were 5 infants who required emergent balloon removal (2 ex utero intrapartum treatment and 3 tracheoscopic removal on placental bypass with delayed cord clamping) and 7 with prenatal balloon removal. Surfactant was administered in 6/12 FETO (50%) infants compared to 2/35 (6%) in the SOC group. Extracorporeal membrane oxygenation use was lower at 25% and survival was higher at 92% compared to 60% and 71% in the SOC infants, respectively.CONCLUSION: The delivery room resuscitation of infants treated with FETO requires thoughtful preparation with an experienced multidisciplinary team. Given increased survival, FETO should be offered to infants with severe isolated left-sided CDH, but only in high-volume centers with the experience and capability of removing the balloon, emergently if needed. The neonatal clinical team must be skilled in managing the unique postnatal physiology inherent to FETO where effective interdisciplinary teamwork is essential. Empiric and immediate surfactant administration should be considered in all FETO infants to lavage thick airway secretions, particularly those delivered &lt;48 h after balloon removal.PMID:38198774 | DOI:10.1159/000536209…
  10 January 2024 12:00 – K Taylor Wild