Latest research on cord clamping

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We will continously blog on our own and others results on cord clamping, as well as other news related to the subject, such as umbilical cord milking and resuscitation.

Latest posts from the blog

Graphic courtesy Satyan Lakshminrusimha Graphic courtesy Satyan Lakshminrusimha

To clamp the umbilical cord more than 3 minutes after birth is essential for term newborns' health and development. Today, my most elaborate work on cord clamping yet is published, a review written together with Judith Mercer , professor in Midwifery, and the author of many important papers on cord clamping for several decades.
We hope to provide an updated, balanced text on the current "knowns and unknowns" regarding the practice of cord clamping, useful for nonprofessionals as well as midwives, obstetricians and neonatologists alike.
https://doi.org/10.1016/j.clp.2021.05.002

Läs hela inlägget »
11 February 2017
In memory of Hans Rosling:
22 January 2017
3 reasons for clamping the umbilical cord after 3 minutes

Research

Latest posts on NEW research

Two of the persons involved in the development of Lifestart trolley (http://www.inditherm.com/medical/neonatal-resuscitation-lifestart/) has published a review in Maternal Health, Neonatology and Perinatology.
"Abstract: The rationale for keeping the mother and her newborn together even when neonatal resuscitation is required is presented. The development of a customised mobile resuscitation trolley is detailed explaining how the resuscitation team can be provided with all the facilities of a standard resuscitation trolley to resuscitate the neonate at the mother’s side with an intact cord. Alternative low tech solutions which may be appropriate in low resource setting and with a low risk population are also described."

http://mhnpjournal.biomedcentral.com/articles/10.1186/s40748-016-0034-9

Läs hela inlägget »
9 July 2015
Delayed clamping vs. milking in preterm infants
12 June 2015
Review on delivery room management of newly born infants
23 May 2015
Cardiac changes during delayed cord clamping
3 May 2015
Delayed cord clamping with and without cord stripping: a prospective randomized trial of preterm neo
12 April 2015
Delayed cord clamping in South African neonates with expected low birthweight

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  • Introduction of a Quality Improvement Bundle Is Associated with Reduced Exposure to Mechanical Ventilation in Very Preterm Infants

    Neonatology. 2021 Sep 1:1-8. doi: 10.1159/000518392. Online ahead of print.ABSTRACTINTRODUCTION: Exposure to mechanical ventilation (MV) is a risk factor for bronchopulmonary dysplasia (BPD) in very preterm infants (VPTIs). We assessed the impact of a quality improvement (QI) bundle in VPTIs (<32 week gestation) on exposure to MV.METHODS: We introduced a QI bundle consisting of deferred cord clamping (DCC), nasal bubble continuous positive airway pressure (bCPAP) in the delivery room (DR), and minimally invasive surfactant therapy (MIST). We compared respiratory outcomes and neonatal morbidity in historical pre-QI (July-December 2017) and prospective post-QI (February-July 2019) cohorts (QICs) of VPTIs. We pre-specified an adjusted analysis to account for the effects of gestational age, sex, antenatal steroids, and any demographic data that significantly differed between cohorts.RESULTS: The pre-QI and post-QICs included 87 and 98 VPTIs, respectively. The post-QIC had decreased rates of MV in the DR (adjusted odds ratio [aOR] 0.26, 95% confidence interval [CI] 0.09-0.71), in the first 72 h of life (aOR 0.27, 95% CI 0.11-0.62) and during admission (aOR 0.28, 95% CI 0.12-0.66). Rates of BPD, combined BPD/death, and BPD severity were similar. The post-QIC was less likely to be discharged with home oxygen (aOR 0.27, 95% CI 0.08-0.91). Necrotising enterocolitis grade ≥2 increased (aOR 19.01, 95% CI 1.93-188.6) in the post-QIC.CONCLUSION: In this rapid-cycle QI study, implementation of a QI bundle consisting of DCC, early nasal bCPAP, and MIST in VPTIs was associated with reduced rates of MV in the DR, in the first 72 h of life and during admission, and reduced need for home oxygen.PMID:34515183 | DOI:10.1159/000518392…
    13 September 2021 12:00 – Stacey Chi-Yan Lo
  • Impact of early respiratory care for extremely preterm infants

    Semin Perinatol. 2021 Aug 21:151478. doi: 10.1016/j.semperi.2021.151478. Online ahead of print.ABSTRACTDespite advances in neonatal intensive care, more than half of surviving infants born extremely preterm (EP; < 28 weeks' gestation) develop bronchopulmonary dysplasia (BPD). Prevention of BPD is critical because of its associated mortality and morbidity, including adverse neurodevelopmental outcomes and respiratory health in later childhood and beyond. The respiratory care of EP infants begins before birth, then continues in the delivery room and throughout the primary hospitalization. This chapter will review the evidence for interventions after birth that might improve outcomes for infants born EP, including the timing of umbilical cord clamping, strategies to avoid or minimize exposure to mechanical ventilation, modes of mechanical ventilation and non-invasive respiratory support, oxygen saturation targets, postnatal corticosteroids and other adjunct therapies.PMID:34474939 | DOI:10.1016/j.semperi.2021.151478…
    3 September 2021 12:00 – Louise S Owen
  • Comparison of intraosseous and intravenous epinephrine administration during resuscitation of asphyxiated newborn lambs

    Arch Dis Child Fetal Neonatal Ed. 2021 Aug 30:fetalneonatal-2021-322638. doi: 10.1136/archdischild-2021-322638. Online ahead of print.ABSTRACTOBJECTIVE: Intraosseous access is recommended as a reasonable alternative for vascular access during newborn resuscitation if umbilical access is unavailable, but there are minimal reported data in newborns. We compared intraosseous with intravenous epinephrine administration during resuscitation of severely asphyxiated lambs at birth.METHODS: Near-term lambs (139 days' gestation) were instrumented antenatally for measurement of carotid and pulmonary blood flow and systemic blood pressure. Intrapartum asphyxia was induced by umbilical cord clamping until asystole. Resuscitation commenced with positive pressure ventilation followed by chest compressions and the lambs received either intraosseous or central intravenous epinephrine (10 μg/kg); epinephrine administration was repeated every 3 min until return of spontaneous circulation (ROSC). The lambs were maintained for 30 min after ROSC. Plasma epinephrine levels were measured before cord clamping, at end asphyxia, and at 3 and 15 min post-ROSC.RESULTS: ROSC was successful in 7 of 9 intraosseous epinephrine lambs and in 10 of 12 intravenous epinephrine lambs. The time and number of epinephrine doses required to achieve ROSC were similar between the groups, as were the achieved plasma epinephrine levels. Lambs in both groups displayed a similar marked overshoot in systemic blood pressure and carotid blood flow after ROSC. Blood gas parameters improved more quickly in the intraosseous lambs in the first 3 min, but were otherwise similar over the 30 min after ROSC.CONCLUSIONS: Intraosseous epinephrine administration results in similar outcomes to intravenous epinephrine during resuscitation of asphyxiated newborn lambs. These findings support the inclusion of intraosseous access as a route for epinephrine administration in current guidelines.PMID:34462318 | DOI:10.1136/archdischild-2021-322638…
    31 August 2021 12:00 – Calum T Roberts
  • Cord Management of the Term Newborn

    Clin Perinatol. 2021 Aug;48(3):447-470. doi: 10.1016/j.clp.2021.05.002.ABSTRACTKeeping the umbilical cord intact after delivery facilitates transition from fetal to neonatal circulation and allows a placental transfusion of a considerable amount of blood. A delay of at least 3 minutes improves neurodevelopmental outcomes in term infants. Although regarded as common sense and practiced by many midwives, implementation of delayed cord clamping into practice has been unduly slow, partly because of beliefs regarding theoretic risks of jaundice and lack of understanding regarding the long-term benefits. This article provides arguments for delaying cord clamping for a minimum of 3 minutes.PMID:34353575 | DOI:10.1016/j.clp.2021.05.002…
    6 August 2021 12:00 – Ola Andersson
  • Use of point of care quality improvement methodology to improve newborn care, immediately after birth, at a tertiary care teaching hospital, in a resource constraint setting

    BMJ Open Qual. 2021 Jul;10(Suppl 1):e001445. doi: 10.1136/bmjoq-2021-001445.ABSTRACTAfter birth, separation of mothers and newborn is a common practice in many hospitals in our country. After delivery, we take the normal newborn to the radiant warmer in the resuscitation area for routine care. This was the existing process of care at our hospital. The frontline delivery team undertook quality improvement initiative to understand and document factors creating challenges in delivering evidence-based practice of providing immediate skin-to-skin care (SSC), delayed cord clamp (DCC) and early breast feeding within 1 hour of birth. Some of the barriers identified were early newborn mother separation and late transfer of mother from delivery room to the observation area. Additionally, there was a challenge of high delivery load with variation in understanding and provision of SSC and drying on mother's abdomen. These made sustenance of improved care practices difficult. Using the Plan-Do-Study-Act (PDSA) approach some successful change ideas tested were pre-delivery counselling, avoiding separation of mother and newborn at birth by providing SSC and continuing it in the post-delivery observation area and getting family member's help in first breast feed. The delivery team adapted these successful change ideas by multiple iterations, group discussions and feedback. This resulted in improved and sustained compliance of pre-delivery counselling, SSC, DCC and initiating breast feed within 1 hour, from minimal compliance to a median compliance of 51%, 56%, 59% and 61%, respectively, over 36 months period. We undertook this quality improvement initiative at Delhi (India) at a tertiary care teaching hospital. The implementation of WHO recommended evidence-based practices benefitted more than 10 000 mother-newborn dyads annually over 2 years, using Point of Care Quality Improvement method. Implementation of evidence-based practice is possible in challenging situations using PDSA approach. The resultant contextualised processes are convenient and have better success at sustainability.PMID:34344737 | PMC:PMC8336133 | DOI:10.1136/bmjoq-2021-001445…
    4 August 2021 12:00 – Ravi Sachan
  • Effect of cord clamping time on neonatal vitamin B12, folate and urinary iodine concentration

    Ginekol Pol. 2021 Jul 15. doi: 10.5603/GP.a2021.0115. Online ahead of print.ABSTRACTOBJECTIVES: The aim of this randomised study was to investigate whether early or late clamping of the cord influences the status of micro-elements and thyroid hormone levels in newborns.MATERIAL AND METHODS: The study participants were randomised into two groups: Group 1, in which cord clamping was performed within 10 s (n = 32) and Group 2, in which clamping was performed at the 60th second (n = 28). Sociodemographic parameters were recorded; maternal and neonatal levels of free triiodothyronine (FT3), free thyroxine (FT4), thyroid stimulant hormone (TSH), urinary iodine concentration levels (UIC) folate and vitamin B12 were measured.RESULTS: Of the maternal and neonatal thyroid hormone values examined, a significant difference was determined between the groups only in respect of the FT4 and FT3 values of the newborns in the first 24 hours (p = 0.037, p = 0.009, respectively). The FT4 values in the first 24 hours were determined to be lower than normal in 15.6% (n: 5) of the newborns in Group 1 and in 0% of Group 2. The FT3 values in the first 24 hours were determined to be lower than normal in 62.5% (n: 20) of the newborns in Group 1 and in 28.5% of Group 2. Vitamin B12 values below the normal limit were determined at a significantly higher rate in Group 1 (p = 0.009). A statistically significant positive correlation was observed between the maternal and neonatal vitamin B12 levels (r: 0.334, p = 0.009).CONCLUSIONS: Late clamping of the umbilical cord may contribute to erythrocyte synthesis by allowing passage of vitamins such as B12 and folic acid to the newborn.PMID:34263919 | DOI:10.5603/GP.a2021.0115…
    15 July 2021 12:00 – Özgül Özgan Çelikel
  • Human Coronavirus Infections and Pregnancy

    Matern Fetal Med. 2020 Sep 21;3(1):53-65. doi: 10.1097/FM9.0000000000000071. eCollection 2021 Jan.ABSTRACTHuman coronavirus (HCoV) causes potentially fatal respiratory disease. Pregnancy is a physiological state that predisposes women to viral infection. In this review, we aim to present advances in the pathogenesis, clinical features, diagnosis, and treatment in HCoV in pregnancy. We retrieved information from the Pubmed database up to June 2020, using various search terms and relevant words, including coronaviruses, severe acute respiratory syndrome coronavirus, Middle East respiratory syndrome coronavirus, 2019 coronavirus disease, and pregnancy. Both basic and clinical studies were selected. We found no evidence that pregnant women are more susceptible to HCoV infection or that those with HCoV infection are more prone to developing severe pneumonia. There is also no confirmed evidence of vertical mother-to-child transmission of HcoV infection during maternal HCoV infection. Those diagnosed with infection should be promptly admitted to a negative-pressure isolation ward, preferably in a designated hospital with adequate facilities and multi-disciplinary expertise to manage critically ill obstetric patients. Antiviral treatment has been routinely used to treat pregnant women with HCoV infection. The timing and mode of delivery should be individualized, depending mainly on the clinical status of the patient, gestational age, and fetal condition. Early cord clamping and temporary separation of the newborn for at least 2 weeks is recommended. All medical staff caring for patients with HCoV infection should use personal protective equipment. This review highlights the advances in pathogenesis, maternal-fetal outcome, maternal-fetal transmission, diagnosis and treatment in HCoV including severe acute respiratory syndrome coronavirus, Middle East respiratory syndrome coronavirus, and coronavirus disease 2019 in pregnancy.PMID:34192279 | PMC:PMC7834663 | DOI:10.1097/FM9.0000000000000071…
    30 June 2021 12:00 – Shangrong Fan
  • Impact evaluation of a maternal and neonatal health training intervention in private Ugandan facilities

    Health Policy Plan. 2021 Aug 12;36(7):1103-1115. doi: 10.1093/heapol/czab072.ABSTRACTGlobal and country-specific targets for reductions in maternal and neonatal mortality in low-resource settings will not be achieved without improvements in the quality of care for optimal facility-based obstetric and newborn care. This global call includes the private sector, which is increasingly serving low-resource pregnant women. The primary aim of this study was to estimate the impact of a clinical and management-training programme delivered by a non-governmental organization [LifeNet International] that partners with clinics on adherence to global standards of clinical quality during labour and delivery in rural Uganda. The secondary aim included describing the effect of the LifeNet training on pre-discharge neonatal and maternal mortality. The LifeNet programme delivered maternal and neonatal clinical trainings over a 10-month period in 2017-18. Direct clinical observations of obstetric deliveries were conducted at baseline (n = 263 pre-intervention) and endline (n = 321 post-intervention) for six faith-based, not-for-profit primary healthcare facilities in the greater Masaka area of Uganda. Direct observation comprised the entire delivery process, from initial client assessment to discharge, and included emergency management (e.g. postpartum haemorrhage and neonatal resuscitation). Data were supplemented by daily facility-based assessments of infrastructure during the study periods. Results showed positive and clinically meaningful increases in observed handwashing, observed delayed cord clamping, partograph use documentation and observed 1- and/or 5-minute APGAR assessments (rapid scoring system for assessing clinical status of newborn), in particular, between baseline and endline. High-quality intrapartum facility-based care is critical for reducing maternal and early neonatal mortality, and this evaluation of the LifeNet intervention indicates that their clinical training programme improved the practice of quality maternal and neonatal healthcare at all six primary care clinics in Uganda, at least over a relatively short-term period. However, for several of these quality indicators, the adherence rates, although improved, were still far from 100% and could benefit from further improvement via refresher trainings and/or a closer examination of the barriers to adherence.PMID:34184060 | PMC:PMC8359744 | DOI:10.1093/heapol/czab072…
    29 June 2021 12:00 – Joy Noel Baumgartner
  • Milking of Umbilical Cord vs Delayed Cord Clamping: Authors' Reply

    Indian Pediatr. 2021 Jun 15;58(6):593.NO ABSTRACTPMID:34176803
    28 June 2021 12:00 – M Jeeva Sankar
  • Milking of Umbilical Cord vs Delayed Cord Clamping

    Indian Pediatr. 2021 Jun 15;58(6):593.NO ABSTRACTPMID:34176802
    28 June 2021 12:00 – Parvathi Jayaprakash
  • Resistin in pregnancy: Analysis of determinants in pairs of umbilical cord blood and maternal serum

    Cytokine X. 2021 Jun 4;3(2):100052. doi: 10.1016/j.cytox.2021.100052. eCollection 2021 Jun.ABSTRACTOBJECTIVE: Despite intensive research on the cytokine resistin only few studies investigated mother-newborn-pairs during healthy pregnancy and reported about interactions with clinical obstetric variables or other cytokines. Comparison of existing studies is difficult due to differences between assays, sample collection, gestational age, definition of healthy controls and patient characteristics. Furthermore, differences between rodent models and humans do not allow for a direct comparison.METHODS: In this cross-sectional, prospective study 109 healthy mother-newborn pairs were analyzed. Maternal venous blood samples were taken on admission to the labor ward; newborn venous blood samples were drawn from the placental part of the umbilical cord (UC), immediately after clamping. Resistin, leptin, adiponectin, TNF-α, IL-6 and brain derived neurotrophic factor (BDNF) serum concentrations were measured with commercially available immunoassays. Determinants of maternal and newborn resistin levels were analyzed using simple and multiple linear regression.RESULTS: UC resistin levels were higher than maternal concentrations (median 17.69 ng/mL, IQR 7.36 vs. median 8.04 ng/mL, IQR 4.30). Correlation between UC and maternal resistin levels was moderate (R = 0.503, p < 0.01). In multiple regression analysis levels of maternal resistin and newborn TNF-α remained significant determining factors for UC resistin levels. Gestational age and maternal BDNF-levels remained significant factors for maternal resistin levels.CONCLUSION: In healthy, term newborns and their respective mothers a positive correlation between maternal and newborn levels and an association with gestational age around term can be found and point to a placental source of resistin. Further investigations are needed to clarify the possible contribution of transplacental transport of resistin into the fetal circulation. Except for gestational age most of the clinical obstetric variables tested do not seem to be determining factors for fetal or maternal resistin. Interactions of resistin with other cytokines like TNF-α and BDNF could be the missing link for the conflicting results in literature.PMID:34151249 | PMC:PMC8192808 | DOI:10.1016/j.cytox.2021.100052…
    21 June 2021 12:00 – Anne Floeck
  • A Questionnaire Assessing Utilization of Delayed Cord Clamping

    Am J Perinatol. 2021 Jun 18. doi: 10.1055/s-0041-1731047. Online ahead of print.ABSTRACTOBJECTIVE: The study aimed to assess the practice of delayed cord clamping (DCC) and the awareness of its benefits for newborns between Obstetric (OB) and neonatal physicians. We examined if provider characteristics including years of experience, level of training, familiarity of the American College of Obstetricians and Gynecologists (ACOG)/American Academy of Pediatrics (AAP) recommendations, institutional policy, and the racial and ethnic background of patient population were associated with implementation of DCC.STUDY DESIGN: This research is a cross-sectional online questionnaire study.RESULTS: 975 questionnaires were returned. Overall, the awareness of ACOG versus AAP recommendations was 94 versus 86% (p < 0.01). 86 versus 78% of OB and neonatal physicians practiced or witnessed DCC >50% of the time, respectively (p < 0.01). An equal number of OB and neonatal physicians believed in the benefits to newborns of DCC. Physicians with >10 years of practice were less likely to acknowledge DCC benefits. Physicians with a majority of non-White patients were less likely to practice/witness DCC (p < 0.05).CONCLUSION: There continues to be room for improvement in the practice of DCC. Institutional policies and awareness of ACOG/AAP recommendations impact the understanding of the benefits of DCC and the likelihood of the practice. There is a significant difference in the practice of DCC among patients with different racial backgrounds. Hospital leadership may consider investing in the education and implementation of updated guidelines to ensure DCC is routinely practiced.KEY POINTS: · Knowledge of AAP/ACOG and institutional policies improved the practice of DCC.. · There is racial disparity in the practice of DCC.. · Physicians in practice for >10 years were less likely to know the benefits of DCC to full-term neonates..PMID:34144627 | DOI:10.1055/s-0041-1731047…
    18 June 2021 12:00 – Shanika R Uduwana
  • Effect of maternal oxytocin on umbilical venous and arterial blood flows during physiological-based cord clamping in preterm lambs

    PLoS One. 2021 Jun 17;16(6):e0253306. doi: 10.1371/journal.pone.0253306. eCollection 2021.ABSTRACTBACKGROUND: Delayed umbilical cord clamping (UCC) after birth is thought to cause placental to infant blood transfusion, but the mechanisms are unknown. It has been suggested that uterine contractions force blood out of the placenta and into the infant during delayed cord clamping. We have investigated the effect of uterine contractions, induced by maternal oxytocin administration, on umbilical artery (UA) and venous (UV) blood flows before and after ventilation onset to determine whether uterine contractions cause placental transfusion in preterm lambs.METHODS AND FINDINGS: At ~128 days of gestation, UA and UV blood flows, pulmonary arterial blood flow (PBF) and carotid arterial (CA) pressures and blood flows were measured in three groups of fetal sheep during delayed UCC; maternal oxytocin following mifepristone, mifepristone alone, and saline controls. Each successive uterine contraction significantly (p<0.05) decreased UV (26.2±6.0 to 14.1±4.5 mL.min-1.kg-1) and UA (41.2±6.3 to 20.7 ± 4.0 mL.min-1.kg-1) flows and increased CA pressure and flow (47.1±3.4 to 52.8±3.5 mmHg and 29.4±2.6 to 37.3±3.4 mL.min-1.kg-1). These flows and pressures were partially restored between contractions, but did not return to pre-oxytocin administration levels. Ventilation onset during DCC increased the effects of uterine contractions on UA and UV flows, with retrograde UA flow (away from the placenta) commonly occurring during diastole.CONCLUSIONS: We found no evidence that amplification of uterine contractions with oxytocin increase placental transfusion during DCC. Instead they decreased both UA and UV flow and caused a net loss of blood from the lamb. Uterine contractions did, however, have significant cardiovascular effects and reduced systemic and cerebral oxygenation.PMID:34138957 | PMC:PMC8211207 | DOI:10.1371/journal.pone.0253306…
    17 June 2021 12:00 – Fiona J Stenning
  • Orexin-A inhibits gamma-aminobutyric acid current of neonatal rat spinal cord ventral horn neurons by activating OX(1)R, OX(2)R and Ca(2+)-independent PKC

    Nan Fang Yi Ke Da Xue Xue Bao. 2021 May 20;41(5):694-701. doi: 10.12122/j.issn.1673-4254.2021.05.09.ABSTRACTOBJECTIVE: To investigate the effect of orexin-A on the functionality of ionotropic γ-aminobutyric acid (GABA) receptors in spinal cord ventral horn neurons and its mechanisms.OBJECTIVE: The spinal cord containing the lumbosacral enlargement was isolated from neonatal SD rats (7-12 days old) and sliced. The slices were digested with papain (in 0.18 g/30 mL artificial cerebrospinal fluid) for 40-60 min, and the ventral horn neurons were separated acutely using fire-polished Pasteur pipettes. After the cells adhered to the bottom of Petri dishes, patch-clamp experiments combined with pharmacological methods were performed to test the effects of orexin-A on GABA currents of the neurons treated with SB334867 (a selective OX1R antagonist), TCSOX229 (a selective OX2R antagonist), Bis-Ⅳ (a PKC inhibitor), PMA (a PKC agonist), Rp-cAMP (a PKA inhibitor), or BAPTA (Ca2+ chelator).OBJECTIVE: The isolated neurons maintained good morphologies with diverse shapes of cell body and long protrusions. Treatment with orexin-A significantly inhibited the amplitude of GABA-induced current (P < 0.001, n=49) with an inhibition rate of (67.48±12.50)%. SB334867 and TCSOX229, when applied simultaneously, completely abolished the suppressive effect of orexin-A on the GABA currents (P=0.93, n=6), and their separate use partially relieved the suppressive effect of orexin-A (P=0.001, n=8; P=0.02, n=8). The application of Bis-Ⅳ also abolished the suppressive effect of orexin-A on GABA currents (P=0.31, n=5). PMA mimicked the effect of orexin-A in these neurons and significantly inhibited GABA currents with an inhibition rate of (60.79±10.94)%, and the application of orexin-A did not cause further suppression of GABA currents in PMA-treated neurons (P=0.15, n=6). Orexin-A was still capable of suppressing GABA currents in Rp-cAMP-treated neurons (P=0.001, n=5). The extracellular Ca2+-free solution (P=0.004, n=8) or the presence of BAPTA (P=0.04, n=7) did not significantly affect the inhibitory effect of orexin-A on GABA currents.OBJECTIVE: Orexin-A inhibits GABA currents in the ventral horn neurons of rat spinal cord probably by activating OX1R, OX2R and Ca2+-independent PKC.PMID:34134956 | PMC:PMC8214956 | DOI:10.12122/j.issn.1673-4254.2021.05.09…
    17 June 2021 12:00 – X Yang
  • Newborns at risk of Covid-19 - lessons from the last year

    J Perinat Med. 2021 Jun 14;49(6):643-649. doi: 10.1515/jpm-2021-0258. Print 2021 Jul 27.ABSTRACTAfter more than 1 year 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. The gap between different guidelines how to handle newborn infants during this pandemic has been minimized, and the American Academy of Pediatrics (AAP)'s recommendations are now more in accordance with those of the World Health Organization (WHO). In this article we summarize present knowledge regarding transmission from mother to the fetus/newborn. Although both vertical and horizontal transmission are rare, SARS-CoV-2 positivity is associated with an increased risk of premature delivery and higher neonatal mortality and morbidity. Mode of delivery and cord clamping routines should not be affected by the mother's SARS-CoV-2 status. Skin to skin contact, rooming in and breastfeeding are recommended with necessary hygiene precautions. Antibodies of infected or vaccinated women seem to cross both the placenta and into breast milk and likely provide protection for the newborn.PMID:34116585 | DOI:10.1515/jpm-2021-0258…
    11 June 2021 12:00 – Malika D Shah
  • Timing of umbilical cord clamping among infants with congenital heart disease

    Prog Pediatr Cardiol. 2020 Dec;59:101318. doi: 10.1016/j.ppedcard.2020.101318. Epub 2020 Oct 28.ABSTRACTThe optimal timing of clamping and cutting the umbilical cord at birth among infants with congenital heart disease (CHD) remains a subject of controversy and debate. The benefits of delayed umbilical cord clamping (DCC) among term infants without CHD are well described, but the evidence base for DCC among infants with CHD has not been characterized adequately. The goals of the present review are to: 1) compare outcomes of DCC versus early cord clamping (ECC) in term (≥37 weeks of gestation) infants; 2) discuss potential risk/benefit profiles in applying DCC among term infants with CHD; 3) use rigorous systematic review methodology to assess the quality and quantity of published reports on cord clamping practices among term infants with CHD; 4) identify needs and opportunities for future research and interdisciplinary collaboration. Our systematic review shows that previous trials have largely excluded infants with CHD. Therefore, the supposition that DCC is advantageous because it is associated with improved neurologic and hematologic outcome is untested in the CHD population. Given that CHD is markedly heterogeneous, to minimize unnecessary and potentially harmful cord clamping practices, identification of subgroups (single-ventricle, cyanotic lesions) most likely to benefit from optimal cord clamping practices is necessary to optimize risk/benefit profiles. The available evidence base suggests that contemporary, pragmatic, randomized controlled trials comparing DCC with ECC among infants with CHD are needed.PMID:34113067 | PMC:PMC8186731 | DOI:10.1016/j.ppedcard.2020.101318…
    11 June 2021 12:00 – Laura Marzec
  • Respiratory support after delayed cord clamping: a prospective cohort study of at-risk births at 35(+0) weeks gestation

    Arch Dis Child Fetal Neonatal Ed. 2021 Jun 10:fetalneonatal-2020-321503. doi: 10.1136/archdischild-2020-321503. Online ahead of print.ABSTRACTOBJECTIVE: To identify risk factors associated with delivery room respiratory support in at-risk infants who are initially vigorous and received delayed cord clamping (DCC).DESIGN: Prospective cohort study.SETTING: Two perinatal centres in Melbourne, Australia.PATIENTS: At-risk infants born at ≥35+0 weeks gestation with a paediatric doctor in attendance who were initially vigorous and received DCC for >60 s.MAIN OUTCOME MEASURES: Delivery room respiratory support defined as facemask positive pressure ventilation, continuous positive airway pressure and/or supplemental oxygen within 10 min of birth.RESULTS: Two hundred and ninety-eight infants born at a median (IQR) gestational age of 39+3 (38+2-40+2) weeks were included. Cord clamping occurred at a median (IQR) of 128 (123-145) s. Forty-four (15%) infants received respiratory support at a median of 214 (IQR 156-326) s after birth. Neonatal unit admission for respiratory distress occurred in 32% of infants receiving delivery room respiratory support vs 1% of infants who did not receive delivery room respiratory support (p<0.001). Risk factors independently associated with delivery room respiratory support were average heart rate (HR) at 90-120 s after birth (determined using three-lead ECG), mode of birth and time to establish regular cries. Decision tree analysis identified that infants at highest risk had an average HR of <165 beats per minute at 90-120 s after birth following caesarean section (risk of 39%). Infants with an average HR of ≥165 beats per minute at 90-120 s after birth were at low risk (5%).CONCLUSIONS: We present a clinical decision pathway for at-risk infants who may benefit from close observation following DCC. Our findings provide a novel perspective of HR beyond the traditional threshold of 100 beats per minute.PMID:34112723 | DOI:10.1136/archdischild-2020-321503…
    11 June 2021 12:00 – Shiraz Badurdeen
  • Characteristics and physiological basis of falls in ventricular outputs after immediate cord clamping at delivery in preterm fetal lambs

    J Physiol. 2021 Aug;599(15):3755-3770. doi: 10.1113/JP281693. Epub 2021 Jul 3.ABSTRACTKEY POINTS: Controversy exists about the physiological mechanism(s) underlying decreases in cardiac output after immediate clamping of the umbilical cord at birth. To define these mechanisms, the four major determinants of ventricular output (afterload, preload, heart rate and contractility) were measured concurrently in fetal lambs at 15 s intervals over a 2 min period after cord clamping and before ventilation following delivery. After cord clamping, right (but not left) ventricular output fell by 20% in the initial 30 s, due to increased afterload associated with higher arterial blood pressures, but both outputs then halved over 45 s, due to a falling heart rate and deteriorating ventricular contractility accompanying rapid declines in arterial oxygenation to asphyxial levels. Ventricular outputs subsequently plateaued from 75 to 120 s, associated with rebound rises in ventricular contractility accompanying asphyxia-induced surges in circulating catecholamines. These findings provide a physiological basis for the clinical recommendation that effective ventilation should occur within 60 s after immediate cord clamping.ABSTRACT: Controversy exists about the physiological mechanism(s) underlying large decreases in cardiac output after immediate clamping of the umbilical cord at birth. To define these mechanisms, anaesthetized preterm fetal lambs (127(1)d, n = 12) were instrumented with flow probes and catheters in major central arteries, and a left ventricular (LV) micromanometer-conductance catheter. Following immediate cord clamping at delivery, haemodynamics, LV and right ventricular (RV) outputs, and LV contractility were measured at 15 s intervals during a 2 min non-ventilatory period, with aortic blood gases and circulating catecholamine (noradrenaline and adrenaline) concentrations measured at 30 s intervals. After cord clamping, (1) RV (but not LV) output fell by 20% in the initial 30 s, due to a reduced stroke volume associated with increased arterial blood pressures, (2) both outputs then halved over the next 45 s, associated with falls in heart rate, arterial blood pressures and ventricular contractility accompanying a rapid decline in arterial oxygenation to asphyxial levels, (3) reduced outputs subsequently plateaued from 75 to 120 s, associated with rebound rises in blood pressures and ventricular contractility accompanying exponential surges in circulating catecholamines. These findings are consistent with a time-dependent decline of ventricular outputs after immediate cord clamping, which comprised (1) an initial, minor fall in RV output related to altered loading conditions, (2) ensuing large decreases in both LV and RV outputs related to the combination of bradycardia and ventricular dysfunction during emergence of an asphyxial state, and (3) subsequent stabilization of reduced LV and RV outputs during ongoing asphyxia, supported by cardiovascular stimulatory effects of marked sympathoadrenal activation.PMID:34101823 | DOI:10.1113/JP281693…
    8 June 2021 12:00 – Joseph J Smolich
  • Differential Alveolar and Systemic Oxygenation during Preterm Resuscitation with 100% Oxygen during Delayed Cord Clamping

    Am J Perinatol. 2021 Jun 1. doi: 10.1055/s-0041-1730362. Online ahead of print.ABSTRACTOBJECTIVE: Delayed cord clamping (DCC) and 21 to 30% O2 resuscitation is recommended for preterm infants but is commonly associated with low pulmonary blood flow (Qp) and hypoxia. 100% O2 supplementation during DCC for 60 seconds followed by 30% O2 may increase Qp and oxygen saturation (SpO2).STUDY DESIGN: Preterm lambs (125-127 days of gestation) were resuscitated with 100% O2 with immediate cord clamping (ICC, n = 7) or ICC + 30% O2, and titrated to target SpO2 (n = 7) or DCC + 100% O2 for 60 seconds, which followed by cord clamping and 30% O2 titration (n = 7). Seven preterm (23-27 weeks of gestation) human infants received continuous positive airway pressure (CPAP) + 100% O2 for 60 seconds during DCC, cord clamping, and 30% O2 supplementation after cord clamping.RESULTS: Preterm lambs in the ICC + 100% O2 group resulted in PaO2 (77 ± 25 mmHg), SpO2 (77 ± 11%), and Qp (27 ± 9 mL/kg/min) at 60 seconds. ICC + 30% O2 led to low Qp (14 ± 3 mL/kg/min), low SpO2 (43 ± 26%), and PaO2 (19 ± 7 mmHg). DCC + 100% O2 led to similar Qp (28 ± 6 mL/kg/min) as ICC + 100% O2 with lower PaO2. In human infants, DCC + CPAP with 100% O2 for 60 seconds, which followed by weaning to 30% resulted in SpO2 of 92 ± 11% with all infants >80% at 5 minutes with 100% survival without severe intraventricular hemorrhage.CONCLUSION: DCC + 100% O2 for 60 seconds increased Qp probably due to transient alveolar hyperoxia with systemic normoxia due to "dilution" by umbilical venous return. Larger translational and clinical studies are warranted to confirm these findings.KEY POINTS: · Transient alveolar hyperoxia during delayed cord clamping can enhance pulmonary vasodilation.. · Placental transfusion buffers systemic oxygen tension and limits hyperoxia.. · Use of 100% oxygen for 60 seconds during DCC was associated with SpO2 ≥80% by 5 minutes..PMID:34062568 | DOI:10.1055/s-0041-1730362…
    1 June 2021 12:00 – Satyan Lakshminrusimha
  • Management of labour, puerperium, and lactation in SARS-CoV-2 positive women. Multicentric study in the Valencian Community

    Enferm Clin. 2021 May-Jun;31(3):184-188. doi: 10.1016/j.enfcli.2021.01.006. Epub 2021 Jan 28.ABSTRACTOBJECTIVE: To determine the maternal and perinatal impact of pregnant women with SARS-CoV-2 positive polymerase chain reaction during childbirth and post clinical period.METHOD: Observational descriptive, retrospective, and multicentre study carried out through the review of clinical records of pregnant women admitted for delivery from 1 March to 30 June 2020.RESULTS: Thirteen women with SARS-CoV-2 positive polymerase chain reaction were tested. The prevalence of positive cases was 0.48% of the total number of births attended during the study period. None of the mothers developed complications from COVID-19 infection, nor did they require admission to the Intensive Care Unit. Of the births,15.4% ended in caesarean section, 7.7% were premature, 53.8% of the newborns were isolated from their mothers, 61.5% had late clamping of the umbilical cord and the rate of exclusive breastfeeding at discharge was 76.9%. All the newborns were polymerase chain reaction-negative for COVID-19 and had no postpartum complications.CONCLUSIONS: Vertical transmission during childbirth in newborns of COVID-19 positive mothers has not been reported. Clinical practices not supported by scientific evidence were detected at the beginning of the pandemic and adapted to international recommendations as the pandemic evolved.PMID:34025117 | PMC:PMC7843032 | DOI:10.1016/j.enfcli.2021.01.006…
    24 May 2021 12:00 – Rafael Vila-Candel
  • The effect of clamped and unclamped umbilical cord samples on blood gas analysis

    Arch Gynecol Obstet. 2021 May 22. doi: 10.1007/s00404-021-06076-w. Online ahead of print.ABSTRACTPURPOSE: Delayed cord clamping for at least 60 s is recommended to improve neonatal outcomes. The aim of this study is to evaluate whether there are differences in cord BGA between samples collected after double clamping the cord or without clamping the cord, when blood collection occurs within 60 s from birth in both groups.METHODS: A cross-sectional study was carried out, collecting data from 6884 high-risk women who were divided into two groups based on the method of cord sampling (clamped vs unclamped).RESULTS: There were significant decrease in pH and BE values into unclamped group compared with the clamped group. This difference remained significant when considering pathological blood gas analysis parameters, with a higher percentage of pathological pH or BE values in the unclamped group.CONCLUSION: Samples from the unclamped cord alter the acid-base parameters compared to collection from the clamped cord; however, this difference does not appear to be of clinical relevance. Findings could be due to the large sample size, which allowed to achieve a high power and to investigate very small numerical changes between groups, leading to a statistically significant difference in pH and BE between samples even when we could not appreciate any clinical relevant difference of pH or BE between groups. When blood gas analysis is indicated, the priority should be given to the timing of blood collection to allow reliable results, to assess newborns status at birth and intervene when needed.PMID:34021806 | DOI:10.1007/s00404-021-06076-w…
    22 May 2021 12:00 – Elisabetta Colciago
  • In utero fetal left ventricular rupture and pseudoaneurysm formation: a case report

    BMC Pregnancy Childbirth. 2021 May 20;21(1):393. doi: 10.1186/s12884-021-03869-4.ABSTRACTBACKGROUND: Cardiac ventricular aneurysms affect 1 in 200,000 live births. To the best of our knowledge, no reported cases of a left ventricular pseudoaneurym and in utero rupture exist to guide optimal management.CASE PRESENTATION: We present a case of fetal left ventricular rupture with a large pericardial effusion, cardiac tamponade and subsequent pseudoaneurysm formation with concerns for a poor prognosis. Interventional drainage of the pericardial effusion led to resolution of tamponade and significant improvement in fetal condition. A multidisciplinary team was utilised to plan birth to minimise risk of pseudoaneurysmal rupture and a catastrophic bleed at birth.CONCLUSION: For similar cases we recommend consideration of birth by caesarean section, delayed cord clamping and a prostaglandin E1 infusion, to reduce the systemic pressures on the left ventricle during transition from fetal to neonatal circulations, until definitive surgical repair. In this case, this resulted in a successful outcome.PMID:34016061 | PMC:PMC8135179 | DOI:10.1186/s12884-021-03869-4…
    21 May 2021 12:00 – Sarah Heland
  • A randomized controlled clinical trial on peripartum effects of delayed versus immediate umbilical cord clamping on term newborns

    Eur J Obstet Gynecol Reprod Biol. 2021 Jul;262:99-104. doi: 10.1016/j.ejogrb.2021.04.038. Epub 2021 May 7.ABSTRACTOBJECTIVES: To compare the hemoglobin and serum bilirubin concentration of term newborn following delayed and immediate umbilical cord clamping.METHODS: A randomized controlled trial of eligible parturients with singleton pregnancy delivered between July 1, 2019 and September 30, 2020 were randomly assigned (1:1 ratio) to either delayed clamping of umbilical cord (60 s after delivery) or immediate clamping (0-15 s) was done. The primary outcome measures included hemoglobin and bilirubin levels of the newborn measured at birth and 48 h of life. Intention-to-treat principle was applied to analysis (www.pactr.org: PACTR201906668876480).RESULTS: One hundred and two newborns were randomized into each group and none was lost to follow-up. Participants in both groups had similar socio-demographic and clinical characteristics. At 0 h of birth, cord blood hemoglobin concentration and total bilirubin values were not significantly different between the two groups (p > 0.05). At 48 h of birth, mean hemoglobin concentration was significantly higher in delayed clamping group than immediate clamping group (16.51 ± 1.71 g/dl vs 15.16 ± 2.27 g/dl; p < 0.001) but total mean bilirubin concentration was not significantly different (3.88 ± 1.54 mg/dl vs 3.71 ± 1.20 mg/dl; p = 0.380). There was no significant difference in postpartum hemorrhage (p = 0.653), neonatal jaundice (p = 0.856), and need for phototherapy (p = 0.561) while respiratory symptoms, polycythemia and anemia were not reported.CONCLUSION: Delayed cord clamping at childbirth is more advantageous for term infants in terms of more hemoglobin concentration compared to traditional immediate cord clamping. The maternal and perinatal complications were either not significantly different or absent.PMID:34004481 | DOI:10.1016/j.ejogrb.2021.04.038…
    18 May 2021 12:00 – Chukwuemeka Jude Ofojebe
  • Normal delivery: physiologic support and medical interventions. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF)

    J Matern Fetal Neonatal Med. 2021 May 12:1-10. doi: 10.1080/14767058.2021.1918089. Online ahead of print.ABSTRACTOBJECTIVE: To define for women at low obstetric risk methods of management that respect the rhythm and the spontaneous course of giving birth as well as each woman's preferences.METHODS: These clinical practice guidelines were developed through professional consensus based on an analysis of the literature and of the French and international guidelines available on this topic.RESULTS: Labor should be monitored with a partograph (professional consensus). Digital cervical examination should be offered every 4 h during the first stage of labor, hourly during the second. The choice between continuous (cardiotocography) or discontinuous (by cardiotocography or intermittent auscultation) monitoring should be left to the woman (professional consensus). In the active phase of the first stage of labor, dilation speed is considered abnormal if it is less than 1 cm/4 h between 5 and 7 cm or less than 1 cm/2 h after 7 cm. In those cases, an amniotomy is recommended if the membranes are intact, and the administration of oxytocin if the membranes are already broken and uterine contractions are judged insufficient (professional consensus). It is recommended that pushing not begin when full dilation has been reached; rather, the fetus should be allowed to descend (grade A). Umbilical cord clamping should be delayed beyond the first 30 s in newborns who do not require resuscitation (grade C).CONCLUSION: The establishment of these clinical practice guidelines should enable women at low obstetric risk to receive better care in conditions of optimal safety while supporting physiologic birth.PMID:33980105 | DOI:10.1080/14767058.2021.1918089…
    13 May 2021 12:00 – Karine Petitprez
  • Components of clean delivery kits and newborn mortality in the Zambia Chlorhexidine Application Trial (ZamCAT): An observational study

    PLoS Med. 2021 May 5;18(5):e1003610. doi: 10.1371/journal.pmed.1003610. eCollection 2021 May.ABSTRACTBACKGROUND: Neonatal infection, a leading cause of neonatal death in low- and middle-income countries, is often caused by pathogens acquired during childbirth. Clean delivery kits (CDKs) have shown efficacy in reducing infection-related perinatal and neonatal mortality. However, there remain gaps in our current knowledge, including the effect of individual components, the timeline of protection, and the benefit of CDKs in home and facility deliveries.METHODS AND FINDINGS: A post hoc secondary analysis was performed using nonrandomized data from the Zambia Chlorhexidine Application Trial (ZamCAT), a community-based, cluster-randomized controlled trial of chlorhexidine umbilical cord care in Southern Province of Zambia from February 2011 to January 2013. CDKs, containing soap, gloves, cord clamps, plastic sheet, razor blade, matches, and candle, were provided to all pregnant women. Field monitors made a home-based visit to each participant 4 days postpartum, during which CDK use and newborn outcomes were ascertained. Logistic regression was used to study the association between different CDK components and neonatal mortality rate (NMR). Of 38,579 deliveries recorded during the study, 36,996 newborns were analyzed after excluding stillbirths and those with missing information. Gloves, cord clamps, and plastic sheets were the most frequently used CDK item combination in both home and facility deliveries. Each of the 7 CDK components was associated with lower NMR in users versus nonusers. Adjusted logistic regression showed that use of gloves (odds ratio [OR] 0.33, 95% CI 0.24-0.46), cord clamp (OR 0.51, 95% CI 0.38-0.68), plastic sheet (OR 0.46, 95% CI 0.34-0.63), and razor blade (OR 0.69, 95% CI 0.53-0.89) were associated with lower risk of newborn mortality. Use of gloves and cord clamp were associated with reduced risk of immediate newborn death (<24 hours). Reduction in risk of early newborn death (1-6 days) was associated with use of gloves, cord clamps, plastic sheets, and razor blades. In examining perinatal mortality (stillbirth plus neonatal death in the first 7 days of life), similar patterns were observed. There was no significant reduction in risk of late newborn mortality (7-28 days) with CDK use. Study limitations included potential recall bias of CDK use and inability to establish causality, as this was a secondary observational study.CONCLUSIONS: CDK use was associated with reductions in early newborn mortality at both home and facility deliveries, especially when certain kit components were used. While causality could not be established in this nonrandomized secondary analysis, given these beneficial associations, scaling up the use of CDKs in rural areas of sub-Saharan Africa may improve neonatal outcomes.TRIAL REGISTRATION: Name of trial: Zambia Chlorhexidine Application Trial (ZamCAT) Name of registry: Clinicaltrials.gov Trial number: NCT01241318.PMID:33951036 | PMC:PMC8133479 | DOI:10.1371/journal.pmed.1003610…
    5 May 2021 12:00 – Jason H Park
  • A Feasibility Study of a Novel Delayed Cord Clamping Cart

    Children (Basel). 2021 Apr 29;8(5):357. doi: 10.3390/children8050357.ABSTRACTDelaying umbilical cord clamping (DCC) for 1 min or longer following a neonate's birth has now been recommended for preterm and term newborns by multiple professional organizations. DCC has been shown to decrease rates of iron deficiency anemia, intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC), and blood transfusion. Despite these benefits, clinicians typically cut the umbilical cord without delay in neonates requiring resuscitation and move them to a radiant warmer for further care; this effectively prevents these patients from receiving any benefits from DCC. This study evaluated the feasibility of a delayed cord clamping cart (DCCC) in low-risk neonates born via Cesarean section (CS). The DCCC is a small, sterile cart designed to facilitate neonatal resuscitation while the umbilical cord remains intact. The cart is cantilevered over the operating room (OR) table during a CS, allowing the patient to be placed onto it immediately after birth. For this study, a sample of 20 low-risk CS cases were chosen from the non-emergency Labor and Delivery surgical case list. The DCCC was utilized for 1 min of DCC in all neonates. The data collected included direct observation by research team members, recorded debriefings and surveys of clinicians as well as surveys of patients. Forty-four care team members participated in written surveys; of these, 16 (36%) were very satisfied, 12 (27%) satisfied, 13 (30%) neutral, and 3 (7%) were somewhat dissatisfied with use of the DCCC in the OR. Feedback was collected from all 20 patients, with 18 (90%) reporting that they felt safe with the device in use. This study provides support that utilizing a DCCC can facilitate DCC with an intact umbilical cord.PMID:33946912 | PMC:PMC8145370 | DOI:10.3390/children8050357…
    5 May 2021 12:00 – Neha S Joshi
  • Efficacy of Intact Cord Resuscitation Compared to Immediate Cord Clamping on Cardiorespiratory Adaptation at Birth in Infants with Isolated Congenital Diaphragmatic Hernia (CHIC)

    Children (Basel). 2021 Apr 26;8(5):339. doi: 10.3390/children8050339.ABSTRACTResuscitation at birth of infants with Congenital Diaphragmatic Hernia (CDH) remains highly challenging because of severe failure of cardiorespiratory adaptation at birth. Usually, the umbilical cord is clamped immediately after birth. Delaying cord clamping while the resuscitation maneuvers are started may: (1) facilitate blood transfer from placenta to baby to augment circulatory blood volume; (2) avoid loss of venous return and decrease in left ventricle filling caused by immediate cord clamping; (3) prevent initial hypoxemia because of sustained uteroplacental gas exchange after birth when the cord is intact. The aim of this trial is to evaluate the efficacy of intact cord resuscitation compared to immediate cord clamping on cardiorespiratory adaptation at birth in infants with isolated CDH. The Congenital Hernia Intact Cord (CHIC) trial is a prospective multicenter open-label randomized controlled trial in two balanced parallel groups. Participants are randomized either immediate cord clamping (the cord will be clamped within the first 15 s after birth) or to intact cord resuscitation group (umbilical cord will be kept intact during the first part of the resuscitation). The primary end-point is the number of infants with APGAR score <4 at 1 min or <7 at 5 min. One hundred eighty participants are expected for this trial. To our knowledge, CHIC is the first study randomized controlled trial evaluating intact cord resuscitation on newborn infant with congenital diaphragmatic hernia. Better cardiorespiratory adaptation is expected when the resuscitation maneuvers are started while the cord is still connected to the placenta.PMID:33925985 | PMC:PMC8146982 | DOI:10.3390/children8050339…
    30 April 2021 12:00 – Kévin Le Duc
  • How to Provide Motherside Neonatal Resuscitation with Intact Placental Circulation?

    Children (Basel). 2021 Apr 8;8(4):291. doi: 10.3390/children8040291.ABSTRACTImmediate clamping and cutting of the umbilical cord have been associated with death and/or neurodisability [...].PMID:33917927 | PMC:PMC8068367 | DOI:10.3390/children8040291…
    30 April 2021 12:00 – David Hutchon
  • Red cell transfusion thresholds for preterm infants: finally some answers

    Arch Dis Child Fetal Neonatal Ed. 2021 Apr 27:fetalneonatal-2020-320495. doi: 10.1136/archdischild-2020-320495. Online ahead of print.ABSTRACTExtremely low birthweight infants become anaemic during their care in the neonatal intensive care unit because of the physiological anaemia experienced by all newborn infants compounded by early umbilical cord clamping, blood loss by phlebotomy for laboratory monitoring and delayed erythropoiesis. The majority of these infants receive transfusions of packed red blood cells, usually based on haemoglobin values below a certain threshold. The haemoglobin or haematocrit thresholds used to guide transfusion practices vary with infant status and among institutions and practitioners. Previous smaller studies have not given clear guidance with respect to the haemoglobin thresholds that should trigger transfusions or even if this is the best way to decide when to transfuse an infant. Two large clinical trials of similar design comparing higher and lower haemoglobin thresholds for transfusing extremely low birthweight infants were recently published, the ETTNO and TOP trials. These trials found reassuringly conclusive and concordant results. Within the range of haemoglobin transfusion thresholds studied, there was no difference in the primary outcome (which was the same in both studies), neurodevelopmental impairment at 2 years' corrected age or death before assessment, in either study. In addition, there was no difference in either study in either of the components of the primary outcome. In conclusion, haemoglobin transfusion thresholds within the ranges used in these trials, 11-13 g/dL for young critically ill or ventilated infants and 7-10 g/dL for stable infants not requiring significant respiratory support, can be safely used without expecting adverse consequences on survival or neurodevelopment.PMID:33906941 | DOI:10.1136/archdischild-2020-320495…
    28 April 2021 12:00 – Edward F Bell
  • Placental transfusion: may the "force" be with the baby

    J Perinatol. 2021 Jun;41(6):1495-1504. doi: 10.1038/s41372-021-01055-0. Epub 2021 Apr 13.ABSTRACTPlacental transfusion results in a significant decrease in the risk of death for extremely preterm infants. With immediate cord clamping (ICC), these infants can leave up to one-half of their normal circulating in utero blood volume in the placenta. Extremely preterm infants are at highest risk of harm from ICC yet are currently the most likely to receive ICC. Receiving a placenta transfusion provides infants with life-saving components and enhanced perfusion. We present some lesser-known but important effects of placental transfusion. New research reveals that enhanced vascular perfusion causes an organ's endothelial cells to release angiocrine responses to guide essential functions. High progesterone levels and pulmonary artery pressure in the first few hours of life assist with neonatal adaptation. We propose that lack of essential blood volume may be a major factor contributing to inflammation, morbidities, and mortality that preterm infants frequently encounter.PMID:33850284 | DOI:10.1038/s41372-021-01055-0…
    14 April 2021 12:00 – Judith S Mercer
  • COVID-19 preparedness-a survey among neonatal care providers in low- and middle-income countries

    J Perinatol. 2021 May;41(5):988-997. doi: 10.1038/s41372-021-01019-4. Epub 2021 Apr 13.ABSTRACTOBJECTIVE: To evaluate COVID-19 pandemic preparedness, available resources, and guidelines for neonatal care delivery among neonatal health care providers in low- and middle-income countries (LMICs) across all continents.STUDY DESIGN: Cross-sectional, web-based survey administered between May and June, 2020.RESULTS: Of 189 invited participants in 69 LMICs, we received 145 (77%) responses from 58 (84%) countries. The pandemic provides significant challenges to neonatal care, particularly in low-income countries. Respondents noted exacerbations of preexisting shortages in staffing, equipment, and isolation capabilities. In Sub-Saharan Africa, 9/35 (26%) respondents noted increased mortality in non-COVID-19-infected infants. Clinical practices on cord clamping, isolation, and breastfeeding varied widely, often not in line with World Health Organization guidelines. Most respondents noted family access restrictions, and limited shared decision-making.CONCLUSIONS: Many LMICs face an exacerbation of preexisting resource challenges for neonatal care during the pandemic. Variable approaches to care delivery and deviations from guidelines provide opportunities for international collaborative improvement.PMID:33850282 | PMC:PMC8042838 | DOI:10.1038/s41372-021-01019-4…
    14 April 2021 12:00 – Claus Klingenberg
  • Risk factors for endotracheal intubation during resuscitation in the delivery room among very preterm infants

    Zhongguo Dang Dai Er Ke Za Zhi. 2021 Apr;23(4):369-374. doi: 10.7499/j.issn.1008-8830.2102004.ABSTRACTOBJECTIVE: To explore the risk factors for endotracheal intubation during resuscitation in the delivery room among very preterm infants.METHODS: A retrospective analysis was performed for 455 very preterm infants who were admitted to the neonatal intensive care unit from January 2017 to December 2019. They were divided into an intubation group (n=79) and a non-intubation group (n=376) according to whether endotracheal intubation was performed during resuscitation. The risk factors for endotracheal intubation during resuscitation were evaluated by multivariate logistic regression analysis.RESULTS: The intubation rate was 17.4% (79/455). Compared with the intubation group, the non-intubation group had significantly higher gestational age, birth weight, and rates of caesarean birth, delayed cord clamping (DCC), resuscitation quality improvement, regular use of antenatal glucocorticoids in mothers and premature rupture of membranes > 18 hours (P < 0.05), but significantly lower rates of maternal gestational diabetes mellitus, placental abruption, placenta previa or placenta previa status, and maternal thyroid dysfunction (P < 0.05). Regular use of antenatal glucocorticoids in mothers (OR=0.368, P < 0.05) and DCC (OR=0.222, P < 0.05) were protective factors against intubation during resuscitation, while younger gestational age, birth weight < 750 g, maternal gestational diabetes mellitus, and placenta previa or placenta previa status were risk factors for intubation during resuscitation (P < 0.05).CONCLUSIONS: Very preterm infants with younger gestational age, birth weight < 750 g, maternal diabetes mellitus, placenta previa or placenta previa status may have a higher risk for endotracheal intubation after birth. The regular use of antenatal glucocorticoids and DCC can reduce the risk of intubation during resuscitation in very preterm infants.PMID:33840409 | PMC:PMC8050545 | DOI:10.7499/j.issn.1008-8830.2102004…
    12 April 2021 12:00 – Jiang-Feng Ou
  • Effect of delayed cord clamping and umbilical cord milking on cerebral hemodynamics in preterm infants: a randomized double-blind controlled trial

    Zhongguo Dang Dai Er Ke Za Zhi. 2021 Apr;23(4):332-337. doi: 10.7499/j.issn.1008-8830.2011158.ABSTRACTOBJECTIVE: To compare the effect of delayed cord clamping (DCC) versus umbilical cord milking (UCM) on cerebral blood flow in preterm infants.METHODS: This was a single-center, prospective, double-blind, randomized controlled trial. A total of 46 preterm infants, with a gestational age of 30-33+6 weeks, who were born in Suining Central Hospital from November 2, 2018 to November 15, 2019 were enrolled and randomly divided into DCC group and UCM group, with 23 infants in each group. The primary outcome indexes included cerebral hemodynamic parameters[peak systolic velocity (PSV), end-diastolic velocity (EDV), and resistance index (RI)] measured by ultrasound within 0.5-1 hour, (24±1) hours, (48±1) hours, and (72±1) hours after birth. Secondary outcome indexes included hematocrit, hemoglobin, red blood cell count, and serum total bilirubin levels on the first day after birth and the incidence rate of intraventricular hemorrhage during hospitalization.RESULTS: A total of 21 preterm infants in the DCC group and 23 in the UCM group were included in the statistical analysis. There was no significant difference in PSV, EDV, and RI between the two groups at all time points after birth (P > 0.05). There was also no significant difference between the two groups in the hematocrit, hemoglobin, red blood cell count and total bilirubin levels on the first day after birth, and the incidence rate of intraventricular hemorrhage during hospitalization (P > 0.05).CONCLUSIONS: DCC and UCM have a similar effect on cerebral hemodynamics in preterm infants with a gestational age of 30-33+6 weeks.PMID:33840403 | PMC:PMC8050552 | DOI:10.7499/j.issn.1008-8830.2011158…
    12 April 2021 12:00 – Ling Lin
  • Umbilical Cord Blood Gas Parameters and Apgar Scoring in Assessment of New-Born Dogs Delivered by Cesarean Section

    Animals (Basel). 2021 Mar 4;11(3):685. doi: 10.3390/ani11030685.ABSTRACTThe article presents the results of the clinical evaluation (Apgar scores, AS) and umbilical cord blood gas analysis (UCBGA) obtained from clamped umbilical cords of newborn pups delivered by the elective Caesarean section. The study was planned as a controlled clinical study, the newborns were allocated into one of the groups, I-critical neonates (severe distress, AS ≤ 3), II-weak neonates (moderate distress, AS 4-6) and III-healthy neonates (no distress, AS ≥ 7). The following parameters were evaluated: pH (pH units), carbon dioxide partial pressure (pCO2; mmHg), oxygen partial pressure (pO2; mmHg), actual bicarbonate (cHCO3-; mmol/L), total carbon dioxide (cTCO2; mmol/L), base excess of extracellular fluid (BE(ecf); mmol/L), base excess of blood (BE(b); mmol/L), oxygen saturation (csO2; %), lactate (Lac; mg/dL), hematocrit (Hct; %PCV), hemoglobin (cHgb; g/dL), glucose (Glu; mg/dL), ions (Na, K, Ca, Cl). The majority of puppies had low AS at birth (AS 4-6 in 38.1% and AS ≤ 3 in 57.1% of the neonates), but most of them (85.7%) improved by the 20th min. reaching AS of 7 and more. Moreover, puppies with lower AS (≤ 3) were at higher risk of death within the first 24h (20.8% did not survive). The positive correlation was found between Apgar score measured at 0 min and pH (r = 0.46, p = 0.01), and between Apgar score (at 0 min) and base excess in whole blood measured [BE(b)] r = 0.36, p = 0.03). Whereas, a negative correlation was detected between Apgar score at 0 and 5th min and glycemia (r = -0.42, p = 0.05, r = -0.34, p = 0.02 respectively. Overall, the puppies with higher glucose levels had lower Apgar scores and were at higher risk of death. Furthermore, in our study, the newborn puppies had mild acidemia with elevated pCO2 levels and the HCO3 at the lower range of normal limits, suggesting the mixed component in the acidemic state. Adaptation to extra-uterine life is crucial and any practical improvement in neonatal diagnostics and care would be beneficial for newborn puppy survival.PMID:33806500 | PMC:PMC8000146 | DOI:10.3390/ani11030685…
    3 April 2021 12:00 – Agnieszka Antończyk
  • Letter to the Editor RE: Implementation of Delayed Cord Clamping Into Neonatal Algorithms

    Pediatrics. 2021 Apr;147(4):e2020049834A. doi: 10.1542/peds.2020-049834A.NO ABSTRACTPMID:33790000 | DOI:10.1542/peds.2020-049834A…
    1 April 2021 12:00 – Stefano Ghirardello
  • Immediate newborn care and breastfeeding: EN-BIRTH multi-country validation study

    BMC Pregnancy Childbirth. 2021 Mar 26;21(Suppl 1):237. doi: 10.1186/s12884-020-03421-w.ABSTRACTBACKGROUND: Immediate newborn care (INC) practices, notably early initiation of breastfeeding (EIBF), are fundamental for newborn health. However, coverage tracking currently relies on household survey data in many settings. "Every Newborn Birth Indicators Research Tracking in Hospitals" (EN-BIRTH) was an observational study validating selected maternal and newborn health indicators. This paper reports results for EIBF.METHODS: The EN-BIRTH study was conducted in five public hospitals in Bangladesh, Nepal, and Tanzania, from July 2017 to July 2018. Clinical observers collected tablet-based, time-stamped data on EIBF and INC practices (skin-to-skin within 1 h of birth, drying, and delayed cord clamping). To assess validity of EIBF measurement, we compared observation as gold standard to register records and women's exit-interview survey reports. Percent agreement was used to assess agreement between EIBF and INC practices. Kaplan Meier survival curves showed timing. Qualitative interviews were conducted to explore barriers/enablers to register recording.RESULTS: Coverage of EIBF among 7802 newborns observed for ≥1 h was low (10.9, 95% CI 3.8-21.0). Survey-reported (53.2, 95% CI 39.4-66.8) and register-recorded results (85.9, 95% CI 58.1-99.6) overestimated coverage compared to observed levels across all hospitals. Registers did not capture other INC practices apart from breastfeeding. Agreement of EIBF with other INC practices was high for skin-to-skin (69.5-93.9%) at four sites, but fair/poor for delayed cord-clamping (47.3-73.5%) and drying (7.3-29.0%). EIBF and skin-to-skin were the most delayed and EIBF rarely happened after caesarean section (0.5-3.6%). Qualitative findings suggested that focusing on accuracy, as well as completeness, contributes to higher quality with register reporting.CONCLUSIONS: Our study highlights the importance of tracking EIBF despite measurement challenges and found low coverage levels, particularly after caesarean births. Both survey-reported and register-recorded data over-estimated coverage. EIBF had a strong agreement with skin-to-skin but is not a simple tracer for other INC indicators. Other INC practices are challenging to measure in surveys, not included in registers, and are likely to require special studies or audits. Continued focus on EIBF is crucial to inform efforts to improve provider practices and increase coverage. Investment and innovation are required to improve measurement.PMID:33765946 | PMC:PMC7995709 | DOI:10.1186/s12884-020-03421-w…
    26 March 2021 11:00 – Tazeen Tahsina
  • Preparedness strategies in neonatology units during the COVID-19 pandemic: A survey conducted at maternity centers in Argentina

    Arch Argent Pediatr. 2021 Apr;119(2):76-82. doi: 10.5546/aap.2021.eng.76.ABSTRACTINTRODUCTION: The objective of this study was to analyze available resources, guidelines in use, and preparedness to care for newborn infants at maternity centers in Argentina during the COVID-19 pandemic.METHOD: Cross-sectional study based on a survey administered to medical and nursing staff. In May 2020, Argentine facilities with more than 500 annual births were contacted; 58 % of these were from the public sector.RESULTS: In total, 104/147 facilities answered (71 %). All had guidelines for care during the pandemic, and 93 % indicated they had been trained on how to use them. A companion was not allowed during childbirth in 26 % of private facilities and in 60 % of public ones (p < 0.01). Deferred cord clamping was recommended in 87 %; rooming-in with asymptomatic newborns was promoted in 62 %; breastfeeding using protective measures was recommended in 70 %; and breast milk using a bottle, in 23 %. In 94 %, family visiting in the Neonatology Unit was restricted. Difficulties included the unavailability of individual rooms for symptomatic newborn infants and a potential shortage of health care staff and personal protective equipment.CONCLUSIONS: All facilities are aware of the national guidelines to fight the pandemic. Most have the resources to comply with the recommended protective measures. There is uncertainty as to whether personal protective equipment, staff, and physical space available at the different facilities would be enough if cases increased significantly.PMID:33749192 | DOI:10.5546/aap.2021.eng.76…
    22 March 2021 11:00 – Sofía C Geffner
  • Neonatal care practices in Buikwe District, Uganda: a qualitative study

    BMC Pregnancy Childbirth. 2021 Mar 17;21(1):213. doi: 10.1186/s12884-021-03699-4.ABSTRACTBACKGROUND: Sub-Saharan Africa is the region with the highest neonatal mortality rate, with Uganda reporting 20 deaths per 1000 live births. The Uganda Clinical Guidelines (UCG) from 2016 have detailed descriptions on care for mothers and their newborns during pregnancy, delivery and the post-partum period. The objective of the study was to identify provider and user perspectives regarding the knowledge of and adherence to the UCG recommendations in aspects of delivery and newborn care, both in cases of normal as well as complicated births.METHODS: The study used qualitative methods with data collection from participant observations, interviews with key-informants and focus group discussions. Malterud's Systematic Text Condensation (STC) was used for analysis.RESULTS: The study found low knowledge about the UCG among the health workers. Various discrepancies between performed hands-on-procedures and the UCG were found related to neonatal care practices, including low use of partograms, uncertainty around timing for cord clamping, routine oronasopharyngeal suction of newborns and inadequate implementation of skin-to-skin care.CONCLUSIONS: Continued focus on systemic strategies for further implementation of the UCG is recommended.PMID:33731047 | PMC:PMC7972211 | DOI:10.1186/s12884-021-03699-4…
    18 March 2021 11:00 – Marte Bodil Roed
  • Intrinsic burst-firing in lamina I spinoparabrachial neurons during adolescence

    Neurosci Lett. 2021 Apr 17;750:135794. doi: 10.1016/j.neulet.2021.135794. Epub 2021 Mar 2.ABSTRACTA subset of glutamatergic interneurons in the neonatal spinal superficial dorsal horn (SDH) exhibits intrinsic burst-firing (i.e. 'pacemaker' activity), which is tightly regulated by persistent, voltage-gated Na+ channels and classic inward-rectifying K+ (Kir2) channels and downregulated over the course of postnatal development. Ascending lamina I projection neurons targeting the parabrachial nucleus (PB) or periaqueductal gray (PAG) can also display pacemaker activity during early life. However, the degree to which the ionic mechanisms driving pacemaker activity are conserved across different cell types in the spinal dorsal horn, as well as whether the intrinsic bursting is restricted to newborn projection neurons, remains to be elucidated. Using in vitro patch clamp recordings from identified lamina I spinoparabrachial neurons in rat spinal cord slices, here we demonstrate that adolescent projection neurons retain their ability to generate pacemaker activity. In contrast to previous findings in lamina I interneurons, pacemaker projection neurons possessed higher membrane capacitance, lower membrane resistance, and a greater Kir-mediated conductance compared to adjacent spinoparabrachial neurons that lacked intrinsic burst-firing. Nonetheless, as previously seen in interneurons, the bath application of riluzole to block persistent Na+ channels significantly dampened pacemaker activity in projection neurons. Collectively, these results suggest that intrinsic burst-firing in the developing dorsal horn can be generated by multiple combinations of ionic conductances, and highlight the need for further investigation into the mechanisms governing pacemaker activity within the major output neurons of the SDH network.PMID:33667599 | PMC:PMC8041151 | DOI:10.1016/j.neulet.2021.135794…
    5 March 2021 12:00 – Jie Li
  • Different classes of antibiotics given to women routinely for preventing infection at caesarean section

    Cochrane Database Syst Rev. 2021 Mar 4;3(3):CD008726. doi: 10.1002/14651858.CD008726.pub3.ABSTRACTBACKGROUND: Caesarean section increases the risk of postpartum infection for women and prophylactic antibiotics have been shown to reduce the incidence; however, there are adverse effects. It is important to identify the most effective class of antibiotics to use and those with the least adverse effects. OBJECTIVES: To determine, from the best available evidence, the balance of benefits and harms between different classes of antibiotic given prophylactically to women undergoing caesarean section, considering their effectiveness in reducing infectious complications for women and adverse effects on both mother and infant.SEARCH METHODS: For this 2020 update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (2 December 2019), and reference lists of retrieved studies.SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing different classes of prophylactic antibiotics given to women undergoing caesarean section. RCTs published in abstract form were also included. We excluded trials that compared drugs with placebo or drugs within a specific class; these are assessed in other Cochrane Reviews. We excluded quasi-RCTs and cross-over trials. Cluster-RCTs were eligible for inclusion but none were identified.DATA COLLECTION AND ANALYSIS: Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. We assessed the certainty of the evidence using the GRADE approach.MAIN RESULTS: We included 39 studies, with 33 providing data (8073 women). Thirty-two studies (7690 women) contributing data administered antibiotics systemically, while one study (383 women) used lavage and was analysed separately. We identified three main comparisons that addressed clinically important questions on antibiotics at caesarean section (all systemic administration), but we only found studies for one comparison, 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors'. We found no studies for the following comparisons: 'antistaphylococcal cephalosporins (1st and 2nd generation) versus lincosamides' and 'antistaphylococcal cephalosporins (1st and 2nd generation) versus lincosamides plus aminoglycosides'. Twenty-seven studies (22 provided data) included comparisons of cephalosporins (only) versus penicillins (only). However for this update, we only pooled data relating to different sub-classes of penicillins and cephalosporins where they are known to have similar spectra of action against agents likely to cause infection at caesarean section. Eight trials, providing data on 1540 women, reported on our main comparison, 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors'. We found data on four other comparisons of cephalosporins (only) versus penicillins (only) using systemic administration: antistaphylococcal cephalosporins (1st and 2nd generation) versus non-antistaphylococcal penicillins (natural and broad spectrum) (9 studies, 3093 women); minimally antistaphylococcal cephalosporins (3rd generation) versus non-antistaphylococcal penicillins (natural and broad spectrum) (4 studies, 854 women); minimally antistaphylococcal cephalosporins (3rd generation) versus broad spectrum penicillins plus betalactamase inhibitors (2 studies, 865 women); and minimally antistaphylococcal cephalosporins (3rd generation) versus broad spectrum and antistaphylococcal penicillins (1 study, 200 women). For other comparisons of different classes of antibiotics, only a small number of trials provided data for each comparison, and in all but one case data were not pooled. For all comparisons, there was a lack of good quality data and important outcomes often included few women. Three of the studies that contributed data were undertaken with drug company funding, one was funded by the hospital, and for all other studies the funding source was not reported. Most of the studies were at unclear risk of selection bias, reporting bias and other biases, partly due to the inclusion of many older trials where trial reports did not provide sufficient methodological information. We undertook GRADE assessment on the only main comparison reported by the included studies, antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors, and the certainty ranged from low to very low, mostly due to concerns about risk of bias, wide confidence intervals (CI), and few events. In terms of the primary outcomes for our main comparison of 'antistaphylococcal cephalosporins (1st and 2nd generation) versus broad spectrum penicillins plus betalactamase inhibitors': only one small study reported sepsis, and there were too few events to identify clear differences between the drugs (risk ratio (RR) 2.37, 95% CI 0.10 to 56.41, 1 study, 75 women, very low-certainty evidence). There may be little or no difference between these antibiotics in preventing endometritis (RR 1.10; 95% CI 0.76 to 1.60, 7 studies, 1161 women; low-certainty evidence). None of the included studies reported on infant sepsis or infant oral thrush. For our secondary outcomes, we found there may be little or no difference between interventions for maternal fever (RR 1.07, 95% CI 0.65 to 1.75, 3 studies, 678 women; low-certainty evidence). We are uncertain of the effects on maternal: wound infection (RR 0.78, 95% CI 0.32 to 1.90, 4 studies, 543 women), urinary tract infection (average RR 0.64, 95% CI 0.11 to 3.73, 4 studies, 496 women), composite adverse effects (RR 0.96, 95% CI 0.09 to 10.50, 2 studies, 468 women), and skin rash (RR 1.08, 95% CI 0.28 to 4.1, 3 studies, 591 women) (all very low certainty evidence). Although maternal allergic reactions were reported by two studies, there were no events. There were no infant outcomes reported in the included studies. For the other comparisons, the results for most outcomes had wide CIs, few studies and few women included. None of the included trials reported on longer-term maternal outcomes, or on any infant outcomes.AUTHORS' CONCLUSIONS: Based on the best currently available evidence, 'antistaphylococcal cephalosporins' and 'broad spectrum penicillins plus betalactamase inhibitors' may have similar efficacy at caesarean section when considering immediate postoperative infection, although we did not have clear evidence for several important outcomes. Most trials administered antibiotics at or after cord clamping, or post-operatively, so results may have limited applicability to current practice which generally favours administration prior to skin incision. We have no data on any infant outcomes, nor on late infections (up to 30 days) in the mother; these are important gaps in the evidence that warrant further research. Antimicrobial resistance is very important but more appropriately investigated by other trial designs.PMID:33661539 | PMC:PMC8092483 | DOI:10.1002/14651858.CD008726.pub3…
    4 March 2021 12:00 – Myfanwy J Williams
  • Delayed cord clamping in healthy term infants: More harm or good?

    Semin Fetal Neonatal Med. 2021 Apr;26(2):101221. doi: 10.1016/j.siny.2021.101221. Epub 2021 Feb 24.ABSTRACTIt is recommended to delay cord clamping in healthy term infants for at least 60- and 180-s in high- and limited-resource environments, as delayed cord clamping lowers the incidence of anemia and iron deficiency and improves neurodevelopment. There are improvements in hemodynamic parameters such as peripheral arterial oxygen saturation, heart rate, cardiac output, and cerebral oxygenation. Historically, delayed cord clamping caused a higher rate of hyperbilirubinemia and phototherapy, but more recent evidence suggests this may no longer be the case. In limited-resource environments delayed cord clamping may reduce anemia and iron deficiency potentially improving neurodevelopmental outcomes. The use of delayed cord clamping in newborn infants with intrauterine growth restriction or monochorionic twins is limited and further evidence is needed before it can be formally recommended.PMID:33653601 | DOI:10.1016/j.siny.2021.101221…
    3 March 2021 12:00 – Marlies Bruckner
  • Umbilical Cord Management at Term and Late Preterm Birth: A Meta-analysis

    Pediatrics. 2021 Mar;147(3):e2020015404. doi: 10.1542/peds.2020-015404.ABSTRACTCONTEXT: The International Liaison Committee on Resuscitation prioritized scientific review of umbilical cord management at term and late preterm birth.OBJECTIVE: To assess effects of umbilical cord management strategies (clamping timing and cord milking) in infants ≥34 weeks' gestational age.DATA SOURCES: Cochrane Central Register of Controlled Trials, Medline, PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and trial registries searched July 2019.STUDY SELECTION: Two authors independently assessed eligibility of randomized controlled trials.DATA EXTRACTION: Two authors independently extracted data and assessed evidence certainty (Grading of Recommendations Assessment, Development and Evaluations).RESULTS: We identified 46 studies (9159 women and their infants) investigating 7 comparisons. Compared with early cord clamping (ECC) <30 seconds, delayed cord clamping (DCC) ≥30 seconds (33 studies), intact-cord milking (1 study), and cut-cord milking (2 studies) probably improve hematologic measures but may not affect survival without neurodisability, anemia in early infancy, or maternal postpartum hemorrhage. No differences in major neonatal morbidities are seen in studies comparing methods of optimizing placental transfusion (DCC versus cut-cord milking [3 studies], longer delays in clamping [7 studies], or physiologic parameters [3 studies]). Strategies that promote increased placental transfusion may be associated with greater phototherapy use. Evidence for all outcomes was low or very low certainty.LIMITATIONS: Incompleteness and low certainty of findings limit applicability.CONCLUSIONS: Compared with ECC, DCC or cord milking increases hemoglobin and hematocrit immediately after birth in infants ≥34 weeks' gestational age. The uncertain effects of DCC and cord milking compared with ECC on major morbidities limit usefulness of available evidence for policy and practice.PMID:33632933 | DOI:10.1542/peds.2020-015404…
    26 February 2021 12:00 – Judith Gomersall
  • Umbilical Cord Management for Newborns &lt;34 Weeks' Gestation: A Meta-analysis

    Pediatrics. 2021 Mar;147(3):e20200576. doi: 10.1542/peds.2020-0576.ABSTRACTCONTEXT: The International Liaison Committee on Resuscitation prioritized scientific review of umbilical cord management strategies at preterm birth.OBJECTIVE: To determine the effects of umbilical cord management strategies (including timing of cord clamping and cord milking) in preterm infants <34 weeks' gestation.DATA SOURCES: Cochrane Central Register of Controlled Trials, Medline, PubMed, Embase, CINAHL, and trial registries were searched through July 2019 for randomized controlled trials assessing timing of cord clamping and/or cord milking.STUDY SELECTION: Two authors independently assessed trial eligibility, extracted data, appraised risk of bias, and assessed evidence certainty (GRADE).DATA EXTRACTION: We identified 42 randomized controlled trials (including 5772 infants) investigating 4 different comparisons of cord management interventions.RESULTS: Compared to early cord clamping, delayed cord clamping (DCC) and intact-cord milking (ICM) may slightly improve survival; however, both are compatible with no effect (DCC: risk ratio: 1.02, 95% confidence interval: 1.00 to 1.04, n = 2988 infants, moderate certainty evidence; ICM: risk ratio: 1.02, 95% confidence interval: 0.98 to 1.06, n = 945 infants, moderate certainty evidence). DCC and ICM both probably improve hematologic measures but may not affect major neonatal morbidities.LIMITATIONS: For many of the included comparisons and outcomes, certainty of evidence was low. Our subgroup analyses were limited by few researchers reporting subgroup data.CONCLUSIONS: DCC appears to be associated with some benefit for infants born <34 weeks. Cord milking needs further evidence to determine potential benefits or harms. The ideal cord management strategy for preterm infants is still unknown, but early clamping may be harmful.PMID:33632931 | PMC:PMC7924139 | DOI:10.1542/peds.2020-0576…
    26 February 2021 12:00 – Anna Lene Seidler
  • Feasibility of Umbilical Cord Blood Collection in Neonates at Risk of Brain Damage-A Step Toward Autologous Cell Therapy for a High-risk Population

    Cell Transplant. 2021 Jan-Dec;30:963689721992065. doi: 10.1177/0963689721992065.ABSTRACTEvidence for umbilical cord blood (UCB) cell therapies as a potential intervention for neurological diseases is emerging. To date, most existing trials worked with allogenic cells, as the collection of autologous UCB from high-risk patients is challenging. In obstetric emergencies the collection cannot be planned. In preterm infants, late cord clamping and anatomic conditions may reduce the availability. The aim of the present study was to assess the feasibility of UCB collection in neonates at increased risk of brain damage. Infants from four high-risk groups were included: newborns with perinatal hypoxemia, gestational age (GA) ≤30 + 0 weeks and/or birthweight <1,500 g, intrauterine growth restriction (IUGR), or monochorionic twins with twin-to-twin transfusion syndrome (TTTS). Feasibility of collection, quantity and quality of obtained UCB [total nucleated cell count (TNC), volume, sterility, and cell viability], and neonatal outcome were assessed. UCB collection was successful in 141 of 177 enrolled patients (hypoxemia n = 10; GA ≤30 + 0 weeks n = 54; IUGR n = 71; TTTS n = 6). Twenty-six cases were missed. The amount of missed cases per month declined over the time. Volume of collected UCB ranged widely (median: 24.5 ml, range: 5.0-102 ml) and contained a median of 0.77 × 108 TNC (range: 0.01-13.0 × 108). TNC and UCB volume correlated significantly with GA. A total of 10.7% (19/177) of included neonates developed brain lesions. To conclude, collection of UCB in neonates at high risk of brain damage is feasible with a multidisciplinary approach and intensive training. High prevalence of brain damage makes UCB collection worthwhile. Collected autologous UCB from mature neonates harbors a sufficient cell count for potential therapy. However, quality and quantity of obtained UCB are critical for potential therapy in preterm infants. Therefore, for extremely preterm infants alternative cell sources such as UCB tissue should be investigated for autologous treatment options because of the low yield of UCB.PMID:33631961 | PMC:PMC7917411 | DOI:10.1177/0963689721992065…
    26 February 2021 12:00 – Angela Segler
  • Impact of Acute and Chronic Hypoxia-Ischemia on the Transitional Circulation

    Pediatrics. 2021 Mar;147(3):e2020016972. doi: 10.1542/peds.2020-016972.ABSTRACTThe transition from intrauterine life to extrauterine existence encompasses significant cardiorespiratory adaptations. These include rapid lung aeration and increase in pulmonary blood flow (PBF). Perinatal asphyxia and fetal growth restriction can severely hamper this transition. Hypoxia is the common denominator in these 2 disease states, with the former characterized by acute insult and the latter by utero-placental insufficiency and a chronic hypoxemic state. Both may manifest as hemodynamic instability. In this review, we emphasize the role of physiologic-based cord clamping in supplementing PBF during transition. The critical role of lung aeration in initiating pulmonary gas exchange and increasing PBF is discussed. Physiologic studies in animal models have enabled greater understanding of the mechanisms and effects of various therapies on transitional circulation. With data from sheep models, we elaborate instrumentation for monitoring of cardiovascular and pulmonary physiology and discuss the combined effect of chest compressions and adrenaline in improving transition at birth. Lastly, physiologic adaptation influencing management in human neonatal cohorts with respect to cardiac and vascular impairments in hypoxic-ischemic encephalopathy and growth restriction is discussed. Impairments in right ventricular function and vascular mechanics hold the key to prognostication and understanding of therapeutic rationale in these critically ill cohorts. The right ventricle and pulmonary circulation seem to be especially affected and may be explored as therapeutic targets. The role of comprehensive assessments using targeted neonatal echocardiography as a longitudinal, reliable, and easily accessible tool, enabling precision medicine facilitating physiologically appropriate treatment choices, is discussed.PMID:33622795 | DOI:10.1542/peds.2020-016972…
    24 February 2021 12:00 – Arvind Sehgal
  • Management of labour, puerperium, and lactation in SARS-CoV-2 positive women. Multicentric study in the Valencian Community

    Enferm Clin (Engl Ed). 2021 May-Jun;31(3):184-188. doi: 10.1016/j.enfcli.2021.01.006. Epub 2021 Jan 28.ABSTRACTOBJECTIVE: To determine the maternal and perinatal impact of pregnant women with SARS-CoV-2 positive polymerase chain reaction during childbirth and post clinical period.METHOD: Observational descriptive, retrospective, and multicentre study carried out through the review of clinical records of pregnant women admitted for delivery from 1 March to 30 June 2020.RESULTS: Thirteen women with SARS-CoV-2 positive polymerase chain reaction were tested. The prevalence of positive cases was 0.48% of the total number of births attended during the study period. None of the mothers developed complications from COVID-19 infection, nor did they require admission to the Intensive Care Unit. Of the births,15.4% ended in caesarean section, 7.7% were premature, 53.8% of the newborns were isolated from their mothers, 61.5% had late clamping of the umbilical cord and the rate of exclusive breastfeeding at discharge was 76.9%. All the newborns were polymerase chain reaction-negative for COVID-19 and had no postpartum complications.CONCLUSIONS: Vertical transmission during childbirth in newborns of COVID-19 positive mothers has not been reported. Clinical practices not supported by scientific evidence were detected at the beginning of the pandemic and adapted to international recommendations as the pandemic evolved.PMID:33610456 | PMC:PMC8059941 | DOI:10.1016/j.enfcli.2021.01.006…
    21 February 2021 12:00 – Rafael Vila-Candel
  • Knowledge and practices of immediate newborn care among midwives in selected health care facilities in Ekiti State, Nigeria

    Pan Afr Med J. 2020 Nov 24;37:263. doi: 10.11604/pamj.2020.37.263.24628. eCollection 2020.ABSTRACTINTRODUCTION: almost 99% of neonatal deaths occur in developing countries and these deaths can be prevented by the presence of a skilled birth attendant during labour. This study therefore assessed the knowledge and practices of midwives towards immediate newborn care.METHODS: this study employed a descriptive cross-sectional design. Eighty nine midwives were selected using purposive sampling technique from the two health facilities. Questionnaire was adapted from helping babies breathe manual. Data collected were analyzed with SPSS version 25 and the results were presented using descriptive statistics.RESULTS: the mean age of the respondents was 33.20 years ± 8.07. More than half of the midwives (56.2%) had a good knowledge on immediate newborn care. About 62.9% had good practices of immediate new born care, though some still carry out some obsolete practices like routine suctioning of the airway of newborns, immediate cleaning/removal of the vernix caseosa with olive oil and immediate cord clamping.CONCLUSION: a bit above average of the midwives had good knowledge about immediate newborn care and some of the midwives still carry out obsolete practices that has been judge as non-beneficial and are not in line with recommendations of World Health Organization/UNICEF on immediate newborn care. This study therefore recommends that midwives undergo training and retraining on immediate newborn care and there should be increased awareness and education on recent up to date practices of immediate newborn care.PMID:33598078 | PMC:PMC7864274 | DOI:10.11604/pamj.2020.37.263.24628…
    18 February 2021 12:00 – Deborah Tolulope Esan
  • Mistreatment of newborns after childbirth in health facilities in Nepal: Results from a prospective cohort observational study

    PLoS One. 2021 Feb 17;16(2):e0246352. doi: 10.1371/journal.pone.0246352. eCollection 2021.ABSTRACTBACKGROUND: Patient experience of care reflects the quality of health care in health facilities. While there are multiple studies documenting abuse and disrespect to women during childbirth, there is limited evidence on the mistreatment of newborns immediately after childbirth. This paper addresses the evidence gap by assessing the prevalence and risk factors associated with mistreatment of newborns after childbirth in Nepal, based on a large-scale observational study.METHODS AND FINDINGS: This is a prospective observational cohort study conducted over a period of 18 months in 4 public referral hospitals in Nepal. All newborns born at the facilities during the study period, who breathed spontaneously and were observed, were included. A set of indicators to measure mistreatment for newborns was analysed. Principal component analysis was used to construct a single newborn mistreatment index. Uni-variate, multi-variate, and multi-level analysis was done to measure the association between the newborn mistreatment index and demographic, obstetric, and neonatal characteristics. A total of 31,804 births of newborns who spontaneously breathed were included. Among the included newborns, 63.0% (95% CI, 62.5-63.5) received medical interventions without taking consent from the parents, 25.0% (95% CI, 24.5-25.5) were not treated with kindness and respect (roughly handled), and 21.4% (95% CI, 20.9-21.8) of them were suctioned with no medical need. Among the newborns, 71.7% (95% CI, 71.2-72.3) had the cord clamped within 1 minute and 77.6% (95% CI, 77.1-78.1) were not breast fed within 1 hour of birth. Only 3.5% (95% CI, 3.2-3.8) were kept in skin to skin contact in the delivery room after birth. The mistreatment index showed maximum variation in mistreatment among those infants born to women of relatively disadvantaged ethnic groups and infants born to women with 2 or previous births. After adjusting for hospital heterogeneity, infants born to women aged 30-34 years (β, -0.041; p value, 0.01) and infants born to women aged 35 years or more (β, -0.064; p value, 0.029) were less mistreated in reference to infants born to women aged 18 years or less. Infants born to women from the relatively disadvantaged (chhetri) ethnic groups (β, 0.077; p value, 0.000) were more likely to be mistreated than the infants born to relatively advantaged (brahmin) ethnic groups. Female newborns (β, 0.016; p value, 0.015) were more likely to be mistreated than male newborns.CONCLUSIONS: The mistreatment of spontaneously breathing newborns is high in public hospitals in Nepal. Mistreatment varied by hospital, maternal ethnicity, maternal age, and sex of the newborn. Reducing mistreatment of newborns will require interventions at policy, health system, and individual level. Further, implementation studies will be required to identify effective interventions to reduce inequity and mistreatment of newborns at birth.PMID:33596224 | PMC:PMC7888656 | DOI:10.1371/journal.pone.0246352…
    17 February 2021 12:00 – Ashish K C
  • Interventions to minimize blood loss in very preterm infants-A systematic review and meta-analysis

    PLoS One. 2021 Feb 8;16(2):e0246353. doi: 10.1371/journal.pone.0246353. eCollection 2021.ABSTRACTBlood loss in the first days of life has been associated with increased morbidity and mortality in very preterm infants. In this systematic review we included randomized controlled trials comparing the effects of interventions to preserve blood volume in the infant from birth, reduce the need for sampling, or limit the blood sampled. Mortality and major neurodevelopmental disabilities were the primary outcomes. Included studies underwent risk of bias-assessment and data extraction by two review authors independently. We used risk ratio or mean difference to evaluate the treatment effect and meta-analysis for pooled results. The certainty of evidence was assessed using GRADE. We included 31 trials enrolling 3,759 infants. Twenty-five trials were pooled in the comparison delayed cord clamping or cord milking vs. immediate cord clamping or no milking. Increasing placental transfusion resulted in lower mortality during the neonatal period (RR 0.51, 95% CI 0.26 to 1.00; participants = 595; trials = 5; I2 = 0%, moderate certainty of evidence) and during first hospitalization (RR 0.70, 95% CI 0.51, 0.96; 10 RCTs, participants = 2,476, low certainty of evidence). The certainty of evidence was very low for the other primary outcomes of this review. The six remaining trials compared devices to monitor glucose levels (three trials), blood sampling from the umbilical cord or from the placenta vs. blood sampling from the infant (2 trials), and devices to reintroduce the blood after analysis vs. conventional blood sampling (1 trial); the certainty of evidence was rated as very low for all outcomes in these comparisons. Increasing placental transfusion at birth may reduce mortality in very preterm infants; However, extremely limited evidence is available to assess the effects of other interventions to reduce blood loss after birth. In future trials, infants could be randomized following placental transfusion to different blood saving approaches. Trial registration: PROSPERO CRD42020159882.PMID:33556082 | PMC:PMC7870155 | DOI:10.1371/journal.pone.0246353…
    8 February 2021 12:00 – Emma Persad
  • Physiology, Neonatal

    2021 May 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–.ABSTRACTThe neonatal period is the period of the most dramatic physiologic changes that occur during human life. While the respiratory and cardiovascular systems change immediately at birth, other organ systems evolve slowly with time until the transition from intrauterine to adult physiology is complete. The transitional period of the newborn is a critical time for humans to adapt to life outside the womb. There are distinct physiologic changes during this period, especially regarding the respiratory and cardiovascular systems. The loss of the low-pressure placenta and its ability to facilitate gas exchange, circulation, and waste management for the fetus creates a need for physiologic adaptation.Premature birth can significantly thwart these physiologic changes from occurring as they should. The endocrine system, specifically the release of cortisol via the hypothalamus, is responsible for lung maturation of the fetus and the neonate. There is a “cortisol surge” that begins with cortisol levels of 5 to 10 mcg/ml at 30 weeks gestational age, 20 mcg/ml at 36 weeks, 46 mcg/ml at 40 weeks, and 200mcg/ml during labor. Cortisol is responsible for lung maturation, thyroid hormone secretion, hepatic gluconeogenesis, catecholamine secretion, and the production of digestive enzymes. Mature thyroid function appears to help prepare the neonatal cardiovascular system and aid in the regulation of temperature. Following clamping of the umbilical cord and the first breath of life, arterial oxygen tension increases, and pulmonary vascular resistance decreases, facilitating gas exchange in the lungs. Subsequent pulmonary blood flow will cause an increase in left atrial pressure and a reduction in right atrial pressure. Changes in the PO2, PCO2, and pH are contributing factors to these physiologic changes in the newborn. Lung surfactant plays a critical role in these changes allowing the lungs to mature upon delivery. Remnants of fetal circulation (ductus arteriosus, foramen ovale, ductus venosus) will also gradually recede during this neonatal period, defined as up to 44 weeks postconceptual age.PMID:30969662 | Bookshelf:NBK539840…
    1 January 2021 12:00 – Tara M. Doherty

ALtimetric score

Measure of how our paper in JAMA Pediatrics 2017 on anemia is spread by media

Measure of how our paper in JAMA Pediatrics 2015 on neurodevelopment is spread by media

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