BLog & News
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
When a baby is born, it's an exciting moment for all involved. But there are still some important decisions to be made in the moments after birth – one of which is when to clamp and cut the umbilical cord. While most parents may feel inclined to do this immediately following delivery, experts suggest that waiting a few minutes has many potential benefits for both mother and child. In this article, we'll discuss three of these advantages associated with delaying umbilical cord clamping.
As soon as a baby enters the world, they must now learn how to survive outside the womb on their own. During this time, having access to blood from the placenta can help them make this transition easier. This vital resource includes essential nutrients like iron along with oxygen-rich red blood cells – giving newborns a much needed boost at such a fragile stage in life. Clamping too quickly can mean depriving your little one of these critical elements right when they require them most.
Finally, delayed cord clamping also offers certain health benefits for mothers as well. When babies receive more placental blood before cutting ties with mom, research suggests it might reduce risk factors associated with postpartum hemorrhage – something no new parent wants to experience! So if you're expecting or already have welcomed your bundle of joy into the family, consider taking extra time before severing that special bond between parent and child via the umbilical cord!
Benefits Of Delayed Cord Clamping
Clamping the umbilical cord is a significant step in childbirth and can have long-term impacts on both mother and baby. Delayed cord clamping has many benefits that should not be overlooked; here we examine three reasons to wait before clamping the umbilical cord.
Firstly, delayed cord clamping helps promote better iron levels in newborns. By waiting for at least 30 seconds after birth to cut the cord, babies can receive more oxygenated blood from mom's placenta, which boosts their iron stores significantly. This allows infants to develop higher hemoglobin levels in their bodies, reducing the risk of anemia down the road into childhood.
Secondly, delayed cord clamping encourages healthy growth in newborns by providing additional nutrients through placental transfusion. Studies show that these unique transfers can increase birth weight and ward off potential problems such as hypoglycemia, bradycardia and respiratory distress syndrome. Allowing time for further placental transfusions may also lead to improved breastfeeding rates since it gives babies access to colostrum – mom's special milk full of antibodies - right away.
Finally, delaying cord clamping allows for longer bonding between mom and baby immediately following birth. Without rushing this process with early clamping, mothers get a chance to experience skin-to-skin contact with their infant shortly after delivery while still connected via the umbilical cord. This provides ample opportunity for moms and babies alike to share meaningful moments together even amidst all the chaos of labor and delivery!
Delaying or avoiding immediate cutting of the umbilical cord comes with several important advantages for parents looking for ways to nurture their little ones throughout pregnancy and beyond. With these numerous benefits associated with delayed cord clamping come certain risks which will be discussed next...
Risks Of Early Cord Clamping
When it comes to clamping the umbilical cord, timing is everything. A newborn’s health and wellbeing depend on when this important step occurs. Early clamping carries its own risks, making delayed clamping a far better option for both mother and baby.
The image of a pair of scissors snipping through the lifeline that connects mother and child can be jarring; however, understanding why early cord clamping must be avoided is crucial. The possible consequences include:
- Impaired iron stores leading to anemia
- Disrupted thermoregulation (body temperature control)
- Difficulty transitioning from intrauterine to extra uterine life
These potential issues run the gamut from mild to severe in their effects – ranging anywhere from short-term fatigue or jaundice to long-term neurodevelopmental impairments. Additionally, as research continues into other areas such as immune system development, more complications may become apparent with early cord clamping.
Given all these considerations, delaying cord clamping until after birth offers many advantages without any known disadvantages. It's essential for parents to have access to accurate information regarding safe delay practices so they can make informed decisions about their care during labor and delivery.
How To Safely Delay Clamping The Umbilical Cord
The umbilical cord is a vital lifeline between mother and child, yet many parents opt to have the umbilical cord clamped immediately after birth. Ironically, this seemingly innocuous action could actually be harmful – so how can you safely delay clamping it?
It’s important not to rush into clamping the umbilical cord. It's best practice that both baby and mother benefit from delayed cord clamping by allowing time for placental transfusion of oxygen-rich blood as well as essential nutrients and iron stores. In addition, waiting a few minutes allows gravity to reduce the pressure in the placenta, which helps reduce bleeding at delivery.
To ensure a safe transition for your newborn, keep him or her warm during skin-to-skin contact with mom (known as “kangaroo care”). This will help maintain their temperature while stabilizing heart rate and respiratory rates. During this time, an experienced midwife should monitor both mother and baby closely, including checking blood pressures every five minutes until stabilized. This period usually lasts about fifteen minutes before considering cutting the umbilical cord if medically necessary.
In order to minimize any risks associated with early clamping of the umbilical cord, delaying for even three more minutes beyond when baby has been delivered gives them valuable extra time on the life-giving connection they shared throughout pregnancy — one last chance to receive what they need before entering into this new world!
Conclusion
In conclusion, waiting to clamp the umbilical cord is beneficial for both the baby and mother. Delayed cord clamping increases a newborn's iron stores and red blood cells, which can help prevent anemia in infancy. It also reduces risks of preterm infants developing intraventricular hemorrhage or necrotizing enterocolitis later on. Additionally, it helps ensure that a newborn receives all the placental transfusions they need while reducing their risk of needing a blood transfusion.
Research shows that delaying cord clamping by just one minute can increase hemoglobin levels in term babies by 10%. So even if you're pressed for time after delivery, taking a minute to wait before cutting the umbilical cord could be life-changing for your little one!
Research
Latest posts on NEW research
The timing of umbilical cord clamping has been a topic of considerable debate in the medical community, particularly concerning preterm infants. A recent study aimed to shed light on this issue and understand how early or delayed cord clamping affects the health outcomes of these vulnerable newborns.
Methodology:
Researchers conducted a study involving 96 pregnant women eagerly awaiting the arrival of their babies. The participants were randomly assigned to one of two groups - early cord clamping (ECC) or delayed cord clamping (DCC). The researchers closely monitored hematological and cardiac changes in the preterm infants, focusing on gestational periods between 24 and 34 weeks, and evaluated the stability of key blood parameters within the first week after birth.
Key Findings:
The study revealed interesting insights into the impact of cord clamping timing. Infants in the DCC group showed higher levels of hemoglobin and hematocrit upon admission, indicating improved oxygen-carrying capacity compared to those in the ECC group. Similarly, by the seventh day of life, the DCC group maintained higher hemoglobin and hematocrit levels, suggesting continued hematological advantages.
However, it should be noted that the DCC group also had a slightly higher incidence of phototherapy usage to treat jaundice compared to the ECC group.
Cardiac parameters and maternal blood tests did not differ significantly between the two groups.
Conclusion:
The study suggests that delayed cord clamping may have certain benefits for preterm infants in terms of hematological outcomes, as evidenced by higher hemoglobin and hematocrit levels. However, it is important to consider that other factors, such as a slightly increased need for phototherapy, should be taken into account.
This study adds valuable insights to the ongoing discussion regarding the optimal timing for cord clamping in preterm births. Further research is warranted to better understand the long-term implications and overall health outcomes associated with cord clamping practices.
Reference: García, C., Prieto, M.T., Escudero, F., Bosh-Giménez, V., Quesada, L., Lewanczyk, M., Pertegal, M., Delgado, J.L., Blanco-Carnero, J.E., De Paco Matallana, C., 2023. The impact of early versus delayed cord clamping on hematological and cardiovascular changes in preterm newborns between 24 and 34 weeks’ gestation: a randomized clinical trial. Archives of Gynecology and Obstetrics.. https://doi.org/10.1007/s00404-023-07119-0
Understanding the Dynamics of Umbilical Cord Circulation and Placental Transfusion: Debunking Common
Newsletter
WHAt Do Others Write

Laddar innehåll...
cord clamping newborn
-
Strengthening evidence-based intrapartum and newborn care practices in medical schools: Subnational implementation research from India
Int J Gynaecol Obstet. 2025 Feb 7. doi: 10.1002/ijgo.70008. Online ahead of print.ABSTRACTOBJECTIVE: We examined the impact of a codesigned multicomponent implementation strategy on adherence to evidence-based intrapartum care, respectful maternity care, and newborn care practices in 11 medical schools across two states and a union territory in India.METHODS: We conducted pre-post implementation research using the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework from July 2019 to October 2021. The implementation strategy was codesigned by researchers and medical school faculty. At baseline and endline, we recruited intranatal (n = 175, 158) and postnatal women (n = 158, 167) with uncomplicated vaginal delivery for observation and interview, respectively. The primary outcome was proportion of uncomplicated deliveries with a composite of avoiding augmentation, avoiding episiotomy, and using alternate birthing positions. We used generalized estimating equations to compare baseline and endline findings and estimated adjusted prevalence odds ratios (APORs).RESULTS: The primary outcome increased from 5.4% at baseline to 17.4% at endline with APOR 3.55 (95% CI: 1.08, 11.66). A decline was observed in not-recommended practices, namely pubic shaving (APOR 0.05, 95% CI: 0.01, 0.18), enema (APOR 0.07, 95% CI: 0.02, 0.22), fundal pressure (APOR 0.05, 95% CI: 0.02, 0.14), episiotomy (APOR 0.75, 95% CI: 0.38, 1.48). Newborn care practices showed the greatest improvements in early initiation of breastfeeding (APOR 42.35, 95% CI: 5.70, 314.61) and delayed cord clamping (APOR 21.28, 95% CI: 6.00, 75.43). Results from postnatal interviews corroborated those from direct observation in the labor room.CONCLUSION: A codesigned multi-component implementation strategy can improve adherence to evidence-based intrapartum and newborn care practices in medical schools.PMID:39921348 | DOI:10.1002/ijgo.70008… -
Postnatal enteral plasma supplementation following birth asphyxia increases fluid retention and kidney health in newborn pigs
Physiol Rep. 2025 Feb;13(3):e70238. doi: 10.14814/phy2.70238.ABSTRACTBirth asphyxia can result in kidney dysfunction, disturbances in systemic electrolytes and fluid balance in newborns. Currently, there is no proven dietary approach to support asphyxiated newborns. This study investigates whether oral plasma supplementation improves kidney function and overall health in asphyxiated newborns. Cesarean-delivered near-term pigs with or without an 8 min intrauterine clamping of the umbilical cord were fed a milk replacer dissolved in water for 24 h in Experiment 1. Pigs were fed 72 h with milk replacers dissolved in either maternal plasma or water in Experiment 2. Blood, urine, and kidney tissue were collected for further analyses. Asphyxia disrupted blood electrolyte balance. And plasma feeding led to higher fluid retention for both asphyxiated and control pigs. Additionally, plasma feeding may also affect kidney development and protect kidneys from asphyxia induced impairments. Birth asphyxia in pigs led to immediate disturbance of electrolyte balance, impaired fluid retention, and kidney impairments. Plasma feeding may improve postnatal newborn hydration and may also improve the condition of kidneys following asphyxia.PMID:39910739 | PMC:PMC11798866 | DOI:10.14814/phy2.70238… -
Cord blood for autologous transfusion in infants with congenital anomalies: Volumes, sterility, and stability during storage
Transfusion. 2025 Jan 14. doi: 10.1111/trf.18134. Online ahead of print.ABSTRACTBACKGROUND: Neonates with congenital anomalies frequently require perioperative allogeneic red blood cell (RBC) transfusion. Whole cord blood for autologous transfusion to neonates may provide an alternative RBC source, but whether sufficient volumes can be collected after delayed cord clamping to reduce allogeneic RBC requirements is unknown.STUDY DESIGN AND METHODS: Inclusion criteria were mothers delivering a viable infant >34 weeks' gestation. Sterile cord blood collection from the umbilical cord was performed at delivery as per routine obstetric indications. During storage at 4°C, we performed weekly blood gases. Blood culture, complete blood count, and hemolysis tests were performed at baseline and day 21. We compared the whole cord blood volume collected with each infant's allogeneic transfusion requirements.RESULTS: 54 collection attempts yielded 49 collections with a mean volume of 54.1 mL (±20.3) after median delayed cord clamping of 46 seconds (IQR 12.0, 60.0). Among 39 blood cultures obtained, 3 grew organisms after vaginal delivery (3/27, 11.0% vs. 0/12, 0% cesarean delivery, p = .54). Hemolysis was stable during storage (baseline vs. day 21, median [IQR], 0.7% [0.4%-0.9%] vs. 0.7% [0.6%-1.1%], p = .08).CONCLUSIONS: Whole cord blood collection following delayed cord clamping was feasible, with volumes equal to 16.7 mL/kg, or one transfusion. Hemolysis was low, and although potassium increased during storage, it was consistent with patterns observed with adult donor stored whole blood. There were no positive blood cultures from collections during cesarean deliveries. Studies are needed to determine whether whole cord blood transfusions improve patient outcomes.PMID:39810392 | DOI:10.1111/trf.18134… -
Evaluation of cord management strategies in intrauterine growth-restricted infants: a systematic review and meta-analysis
Eur J Pediatr. 2025 Jan 10;184(2):125. doi: 10.1007/s00431-024-05956-y.ABSTRACTDelayed cord clamping (DCC) has been widely adopted in both term and preterm infants to improve neonatal outcomes by increasing blood volume and supporting oxygenation. However, the optimal cord management for intrauterine growth-restricted (IUGR) infants is unclear. To systematically review and meta-analyze the effects of DCC compared to early cord clamping (ECC) in IUGR infants. We followed the PRISMA guidelines for meta-analysis. Six databases were searched for randomized controlled trials (RCTs) and observational studies comparing DCC and ECC in IUGR infants, focusing on neonatal resuscitation measures, hematological parameters, morbidities, and mortality. The Cochrane Collaboration tool and Newcastle-Ottawa scale were used for RCTs and observational studies, respectively. Eight studies with 1531 participants were included, comprising six RCTs and two observational studies. Serum ferritin at 3 months and initial Hb were significantly higher in the DCC group (MD: 36.16 ng/ml [95% CI: 34.09, 38.24]), (MD: 1.64 gm/dl [95%CI: 0.88, 2.4]) respectively. The risk of polycythemia was higher in the DCC group (RR 1.88, 95% CI [1.27, 2.8]), without an increase in the peak total serum bilirubin or the need for exchange transfusion. Conclusion: DCC may be beneficial and safe in IUGR infants, improving hematological parameters without affecting neonatal morbidity and mortality. Further high-quality, large trials are needed to confirm these findings and assess neurodevelopmental impact.PMID:39794603 | DOI:10.1007/s00431-024-05956-y… -
Is It Possible to Perform Quality Neonatal CPR While Maintaining Skin-to-Skin Contact? A Crossover Simulation Study
Children (Basel). 2024 Nov 30;11(12):1471. doi: 10.3390/children11121471.ABSTRACTBackground: This study aimed to assess the feasibility and quality of resuscitation maneuvers performed on a newborn over the mother's body while maintaining SSC and delayed cord clamping. Methods: A randomized crossover manikin study compared standard cardiopulmonary resuscitation (Std-CPR) and cardiopulmonary resuscitation during SSC (SSC-CPR). Nursing students (n = 40) were recruited and trained in neonatal CPR. The quality of the CPR, including compression and ventilation variables, was evaluated using Laerdal Resusci Baby QCPR® manikins. Findings: No significant differences were found in the compression variables between the Std-CPR and the SSC-CPR. The quality variables demonstrated comparable results between the two techniques. The quality of the compressions showed medians of 74% for the Std-CPR and 74% for the SSC-CPR (p = 0.79). Similarly, the quality of the ventilations displayed medians of 94% for the Std-CPR and 96% for the SSC-CPR (p = 0.12). The overall CPR quality exhibited medians of 75% for the Std-CPR and 82% for the SSC-CPR (p = 0.06). Conclusions: Performing CPR on a newborn over the mother's body during SSC is feasible and does not compromise the quality of resuscitation maneuvers. This approach may offer advantages in preserving maternal-newborn bonding and optimizing newborn outcomes. Further studies are needed to address the limitations of this research, including the use of simulations that may not fully replicate real-life conditions, the lack of analysis of different types of labor, and the unpredictability of the maternal response during resuscitation.PMID:39767899 | PMC:PMC11674871 | DOI:10.3390/children11121471… -
Physiological versus time based cord clamping in very preterm infants (ABC3): a parallel-group, multicentre, randomised, controlled superiority trial
Lancet Reg Health Eur. 2024 Dec 4;48:101146. doi: 10.1016/j.lanepe.2024.101146. eCollection 2025 Jan.ABSTRACTBACKGROUND: Physiological-based cord clamping (PBCC) in preterm infants is beneficial for cardiovascular transition at birth and may optimize placental transfusion. Whether PBCC can improve clinical outcomes is unknown. The aim of the Aeration, Breathing, Clamping (ABC3) trial was to test whether PBCC results in improved intact survival in very preterm infants.METHODS: The ABC3 trial was a parallel-group, multicentre, randomised, controlled superiority clinical trial conducted in all Dutch tertiary referral centers for perinatal care involving infants born before 30 weeks of gestation. Infants were randomised to either PBCC or time-based delayed cord clamping (TBCC), stratified by gestational age and treatment center. Infants receiving PBCC were stabilised with umbilical cord intact, which was clamped after reaching cardiorespiratory stability (heart rate >100 bpm and SpO2 >85% while supplemental oxygen <40%). In TBCC the cord was clamped after 30-60 s. The primary outcome was survival without major cerebral injury and/or necrotizing enterocolitis. The primary and key secondary analyses were done in both the intention-to-treat and per-protocol populations. The trial was registered with ClinicalTrials.gov (NCT03808051).FINDINGS: From January 25, 2019, through October 2, 2022, 669 infants were randomised (median gestational age 27+5 weeks (IQR 26+2-28+6)) and included in the intention-to-treat population. Intact survival occurred in 241 of 339 infants (71.1%) after PBCC, compared with 223 of 330 (67.6%) after TBCC (odds ratio 1.18, 95% CI 0.84-1.66; absolute risk difference 3.1 %points, 95% CI -11.0 to 15.8, p = 0.33). Pre-specified subgroup analysis showed 69.9% intact survival in male infants after PBCC, compared with 61.8% after TBCC (odds ratio 2.32, 95% CI 1.42-3.78, p for interaction 0.026). Secondary outcomes showed fewer red blood cell transfusions after PBCC (rate ratio 0.83, 95% CI 0.75-0.92, p = 0.0003), lower incidence of late-onset sepsis (27.4% versus 33.3%, odds ratio 0.77, 95% CI 0.62-0.95, p = 0.013) and lower admission temperature (36.3 °C versus 36.7 °C, mean difference -0.5, 95% CI -0.8 to -0.3, p < 0.0001). Parents were less anxious (Likert scale 1.52 (SD 0.97) versus 2.23 (SD 1.35); p < 0.001) and more content (Likert scale 4.74 (SD 0.75) versus 4.49 (SD 0.97); p < 0.001) after PBCC.INTERPRETATION: PBCC in very preterm infants did not increase survival without major cerebral injury or necrotizing enterocolitis compared to TBCC in the entire cohort. A possible beneficial effect in male infants requires confirmation from other trials. PBCC was safe to perform and parents reported more contentment and less anxiety.FUNDING: The Netherlands Organization for Health Research and Development.PMID:39717227 | PMC:PMC11664066 | DOI:10.1016/j.lanepe.2024.101146… -
Anemia in Infants and Children: Evaluation and Treatment
Am Fam Physician. 2024 Dec;110(6):612-620.ABSTRACTAnemia affects more than 269 million children globally, including 1.2 million children in the United States. Although anemia can present with numerous symptoms, children are most often asymptomatic at the time of diagnosis. Anemia in infants and children most often arises from nutritional iron deficiency but can also be a result of genetic hemoglobin disorders, blood loss, infections, and other diseases. In the United States, newborn screening programs assess for various genetic causes of anemia at birth. The US Preventive Services Task Force notes insufficient evidence to recommend universal screening of asymptomatic children in the first year of life; however, the American Academy of Pediatrics recommends screening all children before 1 year of age. Initial laboratory evaluation consists of a complete blood cell count, with further testing dependent on mean corpuscular volume. Microcytic anemia is the most common hematologic disorder in children, with iron deficiency as the most common cause. A recommended dosage of 2 to 6 mg/kg per day of ferrous sulfate is the most effective oral iron supplementation for patients with iron deficiency anemia. Delayed cord clamping at birth might prevent early iron deficiency, but no clinically relevant outcomes are certain. Normocytic anemia is classified by reticulocyte count and can reflect hemolysis (high reticulocyte count) or bone marrow suppression (low reticulocyte count). Macrocytic anemia is less common in children and is typically a result of nutritional deficiencies or poor absorption of cobalamin (vitamin B12) or folate. Pediatric hematology referral might be beneficial for patients who do not respond to treatment, and referrals are critical for any bone marrow suppression that is diagnosed.PMID:39700365… -
Analysis of the current status of red blood cell transfusion in very preterm infants from Chinese Neonatal Network in 2022
Zhonghua Er Ke Za Zhi. 2025 Jan 2;63(1):55-61. doi: 10.3760/cma.j.cn112140-20240913-00639.ABSTRACTObjective: To analyze the current status of red blood cell transfusion in very preterm infants (VPI) (gestational age at birth <32 weeks) from Chinese Neonatal Network (CHNN) in 2022. Methods: This cross-sectional study was based on the CHNN VPI cohort. It included 6 985 VPI admitted to CHNN 89 participating centers within 24 hours after birth in 2022. VPI with major congenital anomalies or those transferred to non-CHNN centers for treatment or discharged against medical advice were excluded. VPI were categorized based on whether they received red blood cell transfusions, their gestational age at birth, the type of respiratory support received during transfusion, and whether the pre-transfusion hemoglobin levels exceeded the thresholds. General characteristics, red blood cell transfusion rates, number of transfusions, timing of the first transfusion, and pre-transfusion hemoglobin levels were compared among different groups. The incidence of adverse outcomes between the group of VPI who received transfusions above the threshold and those who received transfusions below the threshold were compared. Comparison among different groups was conducted using χ2 tests, Kruskal-Wallis H tests, Mann-Whitney U test, and so on. Trends by gestational age at birth were evaluated by Cochran-Armitage tests and Jonckheere-Terpstra tests for trend. Results: Among the 6 985 VPI, 3 865 cases(55.3%) were male, with a gestational age at birth of 30.0 (28.6, 31.0) weeks and a birth weight of (1 302±321) g. Overall, 3 617 cases (51.8%) received red blood cell transfusion, while 3 368 cases (48.2%) did not. The red blood cell transfusion rate was 51.8% (3 617/6 985), with rates of 77.7% (893/1 150) for those born before 28 weeks gestational age and 46.7% (2 724/5 835) for those born between 28 and 31 weeks gestational age. A total of 9 616 times red blood cell transfusions were administered to 3 617 VPI, with 632 times missing pre-transfusion hemoglobin data, and 8 984 times included in the analysis. Of the red blood cell transfusions, 25.6% (2 459/9 616) were administered when invasive respiratory support was required, 51.3% (4 934/9 616) were receiving non-invasive respiratory support, while 23.1% (2 223/9, 616) were given when no respiratory support was needed. Compared to the non-transfusion group, the red blood cell transfusion group had a higher rate of pregnancy-induced hypertension in mothers, lower rates of born via cesarean section and mother's antenatal steroid administration, smaller gestational age, lower birth weight, a higher proportion of small-for-gestational-age, multiple births, and proportions of Apgar score at the 5th minute after birth ≤3 points (all P<0.05). They were also less likely to be female, born in hospital or undergo delayed cord clamping (all P<0.01). Additionally, higher transport risk index of physiologic stability score at admission were observed in the red blood cell transfusion group (P<0.001). The number of red blood cell transfusion was 2 (1, 3) times, with the first transfusion occurring at an age of 18 (8, 29) days, and a pre-transfusion hemoglobin level of 97 (86, 109) g/L. For VPI ≤7 days of age, the pre-transfusion hemoglobin levels for invasive respiratory support, non-invasive respiratory support, or no respiratory support, respectively, with no statistically significant differences between groups (H=5.59, P=0.061). For VPI aged 8 to 21 days and≥22 days, the levels with statistically differences between groups (both P<0.01). Red blood cell transfusions above recommended thresholds were observed in all respiratory support categories at different stages of life, with the highest prevalence in infants aged 8 to 21 days and≥22 days who did not require respiratory support, at 90.1% (264/273) and 91.1%(1 578/1 732), respectively. The rate of necrotizing enterocolitis was higher in the above-threshold group (χ2=10.59,P=0.001), and the duration of hospital stay was longer in the above-threshold group (Z=4.67, P<0.001) compared to the below-threshold group. Conclusions: In 2022, the red blood cell transfusion rate was relatively high among VPI from CHNN. Pre-transfusion hemoglobin levels frequently exceeded recommended transfusion thresholds.PMID:39694563 | DOI:10.3760/cma.j.cn112140-20240913-00639… -
Resuscitation With Placental Circulation Intact Compared With Cord Milking: A Randomized Clinical Trial
JAMA Netw Open. 2024 Dec 2;7(12):e2450476. doi: 10.1001/jamanetworkopen.2024.50476.ABSTRACTIMPORTANCE: Among preterm newborns undergoing resuscitation, delayed cord clamping for 60 seconds is associated with reduced mortality compared with early clamping. However, the effects of longer durations of cord clamping with respiratory support are unknown.OBJECTIVE: To determine whether resuscitating preterm newborns while keeping the placental circulation intact and clamping the cord after a long delay would improve outcomes compared with umbilical cord milking.DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial (PCI Trial) was conducted at 8 Italian neonatal intensive care units from April 2016 through February 2023 and enrolled preterm newborns born between 23 weeks 0 days and 29 weeks 6 days of gestation from singleton pregnancies.INTERVENTIONS: Enrolled newborns were randomly allocated to receive at-birth resuscitation with intact placental circulation for 180 seconds or umbilical cord milking followed by an early cord clamping (within 20 seconds of life).MAIN OUTCOMES AND MEASURES: The primary outcome was the composite end point of death, grade 3 to 4 intraventricular hemorrhage, and bronchopulmonary dysplasia at 36 weeks of postconception age. Prespecified secondary end points were the single components of the composite primary outcome. An intention-to-treat analysis was conducted.RESULTS: Of 212 mother-newborn dyads who were randomized, 209 (median [IQR] gestational age, 27 [26-28] weeks; median [IQR] birth weight, 900 [700-1070] g) were enrolled in the intention-to-treat population; 105 were randomized to the placental circulation intact group, and 104 were randomized to the cord milking group. The composite outcome of death, grade 3 to 4 intraventricular hemorrhage, or bronchopulmonary dysplasia occurred in 35 of 105 newborns (33%) in the placental circulation intact group vs 39 of 104 newborns (38%) in the cord milking group (odds ratio, 0.83; 95% CI, 0.47-1.47; P = .53).CONCLUSIONS AND RELEVANCE: In a randomized clinical trial of preterm newborns at 23 to 29 weeks' gestational age, intact placental resuscitation for 3 minutes did not lower the composite outcome of death, grade 3 to 4 intraventricular hemorrhage, or bronchopulmonary dysplasia compared with umbilical cord milking.TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT02671305.PMID:39671198 | PMC:PMC11645650 | DOI:10.1001/jamanetworkopen.2024.50476… -
Delayed cord clamping: Perceptions, practices and influencers among the healthcare providers of selected healthcare facilities in Bangladesh
PLoS One. 2024 Dec 5;19(12):e0313938. doi: 10.1371/journal.pone.0313938. eCollection 2024.ABSTRACTBACKGROUND: Umbilical cord clamping is a procedure of separating the newborn after birth with varying recommendations worldwide based on the timing of clamping. Although the benefits of delayed cord clamping (DCC) have been acknowledged, there is a lack of understanding regarding healthcare providers' perceptions and practices, particularly in Bangladesh. This study aimed to explore the perceptions, practices, and influencers of DCC among healthcare providers in selected secondary-level healthcare facilities in Bangladesh.METHODS: This qualitative study was conducted at two public healthcare facilities. Purposive sampling was used to select 30 participants for in-depth and key-informant interviews and non-participatory observations for 13 deliveries were done. A thematic analysis approach was employed to identify emerging themes, and interpretive phenomenological analysis of the observations helped verify and contextualise the reported practices. Statistical software N-Vivo (Version-12, Denver) was used for data analysis.RESULTS: Healthcare providers perceived that cord clamping should occur after one to three minutes, primarily informed by international literature, maternal health training, or peer guidance. Providers recognised DCC's benefits, such as enhanced bonding and reduced neonatal blood transfusions, and noted potential risks of early cord clamping like delayed adaptation and hypoxia. Observation of clamping practices revealed that most providers clamped after pulsation stopped or within three minutes, while caesarean sections often required immediate clamping. Variations existed in the number and type of clamps, with an absence of standardised guidelines. Influencing factors include the cultural impact of Traditional Birth Attendants (Dais), lack of formal training, clinical emergencies, and service delivery challenges such as high patient volumes and staff shortages. Peer learning was a major influencer of practices.CONCLUSION: Despite having a perception regarding DCC, gaps were identified in the practice of healthcare providers. Addressing this gap and the identified influencers will require the involvement of healthcare workers, guidance developers and planners across policy and practice.PMID:39637014 | PMC:PMC11620601 | DOI:10.1371/journal.pone.0313938… -
Clinical Guidelines for Management of Infants Born before 25 Weeks of Gestation: How Representative Is the Current Evidence?
J Pediatr. 2024 Nov 28;278:114423. doi: 10.1016/j.jpeds.2024.114423. Online ahead of print.ABSTRACTOBJECTIVE: To determine whether management guidelines for infants born extremely preterm are representative for those infants <25 weeks of gestation.STUDY DESIGN: Three guidelines were reviewed: the 2022 European Consensus Guidelines on the Management of Respiratory Distress Syndrome, the 2017 American Academy of Pediatrics Guidelines for Perinatal Care, and the 2020/2021 International Liaison Committee on Resuscitation guidelines. All referenced studies for overlapping recommendations were reviewed. Data extracted included the total number and proportion of infants <25 weeks of gestation in the original articles referred in the guidelines. Where the exact number of infants <25 weeks of gestation was unobtainable, this was conservatively estimated by statistical deduction.RESULTS: Eight recommendations were included in 2 or more guidelines: (1) antenatal corticosteroids, (2) antenatal magnesium sulfate, (3) delayed cord clamping, (4) thermoregulation at birth, (5) initial oxygen concentration at birth, (6) continuous positive airway pressure, (7) surfactant, and (8) parenteral nutrition. In total, 519 studies (n = 409 986) informed these 8 recommendations, of which 335 (64.5%) were randomized controlled trials (n = 78 325). Across all studies, an estimated 59 360 (14.5%) infants were <25 weeks of gestation. Within randomized controlled trials alone, an estimated 5873 (7.5%) infants were <25 weeks of gestation. A total of 196 (37.8%) studies did not include any infants <25 weeks of gestation.CONCLUSIONS: Infants born <25 weeks of gestation are not well-represented in the evidence used to develop major clinical guidelines for infants born extremely preterm. Future studies should provide evidence for this population as a distinct cohort.PMID:39613140 | DOI:10.1016/j.jpeds.2024.114423… -
Reference Ranges for Preductal Oxygen Saturation and Heart Rate in Moderate and Late Preterm Infants with Deferred Cord Clamping
Neonatology. 2024 Nov 23:1-10. doi: 10.1159/000542792. Online ahead of print.ABSTRACTINTRODUCTION: Moderate and late preterm (MLPT) infants represent a substantial percentage of all preterm infants and frequently need support in the delivery room. Deferred cord clamping (DCC) improves SpO2 and heart rate (HR) stabilization in term infants. However, data on MLPT infants are limited.METHODS: We performed a prospective observational study collecting SpO2 and HR by pulse oximetry in healthy MLPT infants with DDC to construct percentile graphs for the first 10 min after birth.RESULTS: A total of 96 MLPT infants were monitored for preductal SpO2 and HR, and percentiles were calculated. SpO2 mean was significantly lower for MLPT than for term infants during the first 6 min after birth, and 15% did not achieve SpO2 ≥85% in the first 5 min after birth. HR was significantly lower in MLPT infants in the first 4 min after birth; however, HR consistently remained above bradycardic values (>100 bpm). NICU admission and postnatal complications were not different between MLPT achieving SpO2 ≥85% or not.CONCLUSION: MLPT infants with DCC achieved stable SpO2 and HR significantly later, 6 min and 4 min, respectively, than term infants. In addition, 15% of MLPT infants did not achieve SpO2 ≥85% at 5 min after birth. However, admission to the NICU and clinical evolution did not differ from newborns with SpO2 ≥85% at 5 min. Larger studies including long-term follow-up are needed to assess if lower SpO2 in the first 5 min has clinical consequences in non-resuscitated MLPT.PMID:39581183 | DOI:10.1159/000542792… -
Retraction Note: Early or delayed cord clamping during transition of term newborns: does it make any difference in cerebral tissue oxygenation?
Ital J Pediatr. 2024 Nov 22;50(1):249. doi: 10.1186/s13052-024-01823-6.NO ABSTRACTPMID:39574176 | PMC:PMC11583459 | DOI:10.1186/s13052-024-01823-6… -
Immediate Care for Common Conditions in Term and Preterm Neonates: The Evidence
Neonatology. 2024 Nov 12:1-23. doi: 10.1159/000541037. Online ahead of print.ABSTRACTBACKGROUND: Several interventions provided to newborns at birth or within 24 h after birth have been proven critical in improving neonatal survival and other birth outcomes. We aimed to provide an update on the effectiveness and safety of these interventions in low- and middle-income countries (LMICs).SUMMARY: Following a comprehensive scoping of the literature, we updated or re-analyzed the LMIC-specific evidence for included topics. Ninety-four LMIC studies were identified. Delayed cord clamping with immediate neonatal care after cord clamping resulted in a lower risk of blood transfusion in newborns <32-34 gestational weeks and a lower occurrence of anemia in term newborns but did not have significant effect on neonatal mortality or other common morbidities both in preterm and term newborns. Immediate thermal care using plastic wrap/bag led to a 38% lower risk of hypothermia and a higher axillary temperature in preterm newborns without increasing the risk of hyperthermia. Kangaroo mother care initiated immediately (iKMC) or early after birth (eKMC, within 24 h) significantly reduced neonatal mortality and the occurrence of hypothermia in preterm or low-birth-weight neonates. For delayed first bath in newborns, no pooled estimate was generated due to high heterogeneity of included studies. Trials from high-income countries demonstrated anti-D's effectiveness in lowering the incidence of Rhesus D alloimmunization in subsequent pregnancy if given within 72 h postpartum.KEY MESSAGES: We generated the most updated LMIC evidence for several immediate newborn care interventions. Despite their effectiveness and safety in improving some of the neonatal outcomes, further high-quality trials are necessary.PMID:39532078 | DOI:10.1159/000541037… -
The cardiopulmonary benefits of physiologically based cord clamping persist for at least 8 hours in lambs with a diaphragmatic hernia
Front Pediatr. 2024 Oct 11;12:1451497. doi: 10.3389/fped.2024.1451497. eCollection 2024.ABSTRACTINTRODUCTION: Infants with congenital diaphragmatic hernia can suffer severe respiratory insufficiency and pulmonary hypertension after birth. Aerating the lungs before removing placental support (physiologically based cord clamping, PBCC) increases pulmonary blood flow (PBF) and reduces pulmonary vascular resistance (PVR) in lambs with a diaphragmatic hernia (DH). We hypothesized that these benefits of PBCC persist for at least 8 h after birth.METHODS: At ∼138 days of gestation age (dGA), 21 lambs with a surgically induced left-sided DH (∼86 dGA) were delivered via cesarean section. The umbilical cord was clamped either before ventilation onset (immediate cord clamping, ICC, n = 9) or after achieving a tidal volume of 4 ml/kg, with a maximum delay of 10 min (PBCC, n = 12). The lambs were ventilated for 8 h, initially with conventional mechanical ventilation, but were switched to high-frequency oscillatory ventilation after 30 min if required. Ventilatory parameters, cardiopulmonary physiology, and arterial blood gases were measured throughout the study.RESULTS: PBF increased after ventilation onset in both groups and was higher in the PBCC DH lambs than the ICC DH lambs at 8 h (5.2 ± 1.2 vs. 1.9 ± 0.3 ml/min/g; p < 0.05). Measured over the entire 8-h ventilation period, PBF was significantly greater (p = 0.003) and PVR was significantly lower (p = 0.0002) in the PBCC DH lambs compared to the ICC DH lambs. A high incidence of pneumothoraces in both the PBCC (58%) and ICC (55%) lambs contributed to a reduced sample size at 8 h (ICC n = 4 and PBCC n = 4).CONCLUSION: Compared with ICC, PBCC increased PBF and reduced PVR in DH lambs and the effects were sustained for at least 8 h after ventilation onset.PMID:39463733 | PMC:PMC11502373 | DOI:10.3389/fped.2024.1451497… -
A Study on the Effect of Umbilical Cord Milking Along With Delayed Cord Clamping on Hematological Parameters in Comparison to Delayed Cord Clamping Alone in Moderate-to-Late Preterm Newborns
Cureus. 2024 Sep 12;16(9):e69256. doi: 10.7759/cureus.69256. eCollection 2024 Sep.ABSTRACTBackground Anemia, particularly iron deficiency anemia (IDA), is a global public health issue with serious implications for infant cognitive and developmental outcomes. Preterm infants are especially vulnerable to IDA due to reduced placental blood transfer at birth. Delayed cord clamping (DCC) and umbilical cord milking (UCM) are interventions aimed at enhancing this blood transfer, thereby improving neonatal iron status. While DCC allows passive blood transfer by delaying cord clamping, UCM actively expedites the process. However, there remains a lack of consensus on the comparative benefits of these methods, particularly in preterm infants. This study aims to clarify the efficacy of UCM combined with DCC versus DCC alone in improving hematological outcomes in moderate-to-late preterm newborns. Methodology This comparative study was conducted at Maharaja Agrasen Medical College, Agroha, Hisar, Haryana, over a 12-month period. The study included 200 moderate-to-late preterm infants (32-36+6 weeks of gestation), divided into two groups: Group A (DCC alone) and Group B (DCC combined with UCM). The study aimed to compare the effects of these two interventions on hematological outcomes. Data were collected on baseline characteristics, birth weight, hemoglobin (Hb) levels at birth and at six weeks, serum ferritin levels at six weeks, and any complications. Statistical analyses included independent t-tests for continuous variables and chi-squared tests for categorical variables to assess the differences between the two groups. Results There were no significant differences in the baseline characteristics, birth weight, or clamping time between the two groups. Mean Hb levels at birth were 15.46 g/dL in the DCC group and 15.72 g/dL in the DCC+UCM group (p = 0.429). At six weeks, the mean Hb levels were 13.10 g/dL for the DCC and 13.24 g/dL for the DCC+UCM (p = 0.541). Serum ferritin levels at six weeks were 239.26 ng/mL for the DCC and 258.06 ng/mL for DCC+UCM (p = 0.146). Complications were similar between the groups, with no significant differences in the rates of intraventricular hemorrhage (IVH), jaundice, or polycythemia. Conclusion In this study, the combination of UCM with DCC did not show significant differences in hematological outcomes compared to DCC alone in moderate-to-late preterm infants. Both interventions demonstrated similar results for hemoglobin and ferritin levels, and there were no notable differences in adverse outcomes. Further research with larger sample sizes and longer follow-ups is necessary to better understand the potential benefits of UCM in preterm neonates.PMID:39403649 | PMC:PMC11472205 | DOI:10.7759/cureus.69256… -
Oxygenation associated with cord management strategies among preterm infants
J Perinatol. 2025 Jan;45(1):55-62. doi: 10.1038/s41372-024-02127-7. Epub 2024 Oct 11.ABSTRACTOBJECTIVE: Compare changes in SpO2 and FiO2 post-birth among preterm infants after delayed cord clamping (DCC), umbilical cord milking (UCM) or early cord clamping (ECC).STUDY DESIGN: Retrospective study of infants <32 weeks gestation born between 2014 and 2021. ECC was clamping 0-59 s, DCC was clamping ≥60 s after delivery, UCM defined as milking the intact umbilical cord several times before clamping.RESULTS: Of 463 infants; 257 received DCC, 168 received UCM, 38 received ECC. UCM infants had higher median SpO2 values at 4-(79% UCM vs 69% DCC, p = 0.027) and 5-(85% UCM vs 80% DCC, p = 0.023) minutes after-birth compared to DCC. DCC and UCM infants required lower FiO2 levels in the first 5-minutes compared to ECC infants (DCC 0.38 ± 0.17, UCM 0.40 ± 0.20 vs ECC 0.51 ± 0.27, p's <0.001).CONCLUSION: The proportion of infants achieving SpO2 ≥ 80% by 5 min was similar in all groups, FiO2 needed to achieve this goal was higher in ECC infants.PMID:39394453 | DOI:10.1038/s41372-024-02127-7… -
Association of delayed cord clamping with acute kidney injury and two-year kidney outcomes in extremely premature neonates: a secondary analysis of the preterm erythropoietin neuroprotection trial (PENUT)
J Perinatol. 2025 Jan;45(1):85-93. doi: 10.1038/s41372-024-02143-7. Epub 2024 Oct 11.ABSTRACTBACKGROUND: Delayed cord clamping (DCC) occurs in most preterm births.OBJECTIVE: Evaluate the association of DCC with acute kidney injury (AKI) and two-year kidney outcomes.METHODS: Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial of neonates born 240/7 to 276/7 weeks gestation. AKI and two year kidney outcomes were compared in neonates with DCC ( ≥ 30 s after delivery) to those with early cord clamping (ECC) (<30 s after delivery).RESULTS: The incidence and severity of AKI did not differ between the DCC and ECC groups (aOR 1.17 [95%CI 0.76-1.80]). At two years corrected age, DCC was associated with a 4.5-fold increased adjusted odds of estimated glomerular filtration rate (eGFR) <90 mL/min/1.73m2. No significant associations were noted between DCC and albuminuria or elevated blood pressure.CONCLUSIONS: DCC was not associated with decreased neonatal AKI, but was associated with higher adjusted odds of eGFR <90 mL/min/1.73m2 at two years.PMID:39390245 | DOI:10.1038/s41372-024-02143-7… -
Revolutionizing Neonatal Care: A Comprehensive Review of Intact Cord Resuscitation in Newborns
Cureus. 2024 Sep 8;16(9):e68924. doi: 10.7759/cureus.68924. eCollection 2024 Sep.ABSTRACTNeonatal resuscitation is a critical procedure aimed at ensuring the successful transition of newborns from intrauterine to extrauterine life. Traditionally, this involves immediate clamping and cutting of the umbilical cord, but recent advances have introduced intact cord resuscitation (ICR) as an alternative approach. This review aims to comprehensively analyze ICR, exploring its evolution, scientific basis, and clinical evidence. It seeks to evaluate the benefits and challenges associated with ICR and assess its impact on neonatal outcomes compared to traditional practices. A thorough review of the literature was conducted, including historical perspectives on neonatal resuscitation, the physiological rationale behind ICR, and critical clinical studies and trials. Current guidelines and recommendations were also examined, along with technological advancements and practical implementation issues. Evidence indicates that ICR offers significant benefits, including improved blood volume, better cardiovascular stability, and reduced risk of anemia in newborns. Comparative studies suggest that ICR can enhance neonatal outcomes and support a smoother transition to extrauterine life. Despite these benefits, challenges related to implementation and adherence to new practices persist. ICR represents a promising advancement in neonatal care, potentially improving newborns' health outcomes. Continued research and refinement of guidelines are necessary to fully integrate ICR into standard practice and address existing implementation challenges. This review highlights the need for ongoing evaluation and adaptation of resuscitation practices to optimize neonatal health and care.PMID:39381456 | PMC:PMC11459599 | DOI:10.7759/cureus.68924… -
Deferred Cord Clamping in Twin Pregnancies Across Canada: A National Survey of Practices
J Obstet Gynaecol Can. 2024 Nov;46(11):102659. doi: 10.1016/j.jogc.2024.102659. Epub 2024 Sep 12.ABSTRACTOBJECTIVE: Guidelines recommending deferred cord clamping (DCC), delaying cord clamping for at least 30 seconds post-birth, have shown significant benefits in preterm singleton births. However, evidence supporting DCC in twins is scarce due to limited trial data, leading to practice variations. This study aims to assess current reported DCC practices for twin pregnancies in tertiary hospitals across Canada.METHODS: A web-based survey was distributed to neonatologists and obstetrician investigators associated with the Canadian Neonatal and Preterm Birth Networks operating maternity and neonatal units.RESULTS: The site response rate was 93% (28/30 sites), with 83% (25/30) for neonatologists and 56% (17/30) for obstetricians. The majority had a local protocol for twin pregnancies (obstetricians 13/17, neonatologists 21/25). While all centres practised DCC in dichorionic-diamniotic twins, a difference was noted for monochorionic-diamniotic twins, with 56% of neonatologists and 65% of obstetricians performing DCC. During cesarean delivery, most obstetricians (76.5%) placed the firstborn on the mother's thighs. Neonatologists varied in their practices, with 32% placing the baby on the mother's abdomen, 32% on the mother's thighs, and 28% holding the baby at the height of the perineum. Divergent opinions were observed regarding contraindications, including risks of postpartum hemorrhage and velamentous cord insertion.CONCLUSIONS: DCC is reported to be practised in most twin deliveries among Canadian Neonatal and Preterm Birth Network centres. However, there are wide variations in practice, especially concerning the characteristics of the twins in which DCC is performed. Future research should investigate optimal cord clamping management in twins to standardize practices and maximize benefits.PMID:39260619 | DOI:10.1016/j.jogc.2024.102659… -
Evaluating the efficacy of endotracheal and intranasal epinephrine administration in severely asphyxic bradycardic newborn lambs: a randomised preclinical study
Arch Dis Child Fetal Neonatal Ed. 2024 Sep 4:fetalneonatal-2024-327348. doi: 10.1136/archdischild-2024-327348. Online ahead of print.ABSTRACTOBJECTIVE: Intravenous epinephrine administration is preferred during neonatal resuscitation, but may not always be rapidly administered due to lack of equipment or trained staff. We aimed to compare the time to return of spontaneous circulation (ROSC) and post-ROSC haemodynamics between intravenous, endotracheal (ET) and intranasal (IN) epinephrine in severely asphyxic, bradycardic newborn lambs.METHODS: After instrumentation, severe asphyxia (heart rate <60 bpm, blood pressure ~10 mm Hg) was induced by clamping the cord in near-term lambs. Resuscitation was initiated with ventilation followed by chest compressions. Lambs were randomly assigned to receive intravenous (0.02 mg/kg), ET (0.1 mg/kg) or IN (0.1 mg/kg) epinephrine. If ROSC was not achieved after three allocated treatment doses, rescue intravenous epinephrine was administered. After ROSC, lambs were ventilated for 60 min.RESULTS: ROSC in response to allocated treatment occurred in 8/8 (100%) intravenous lambs, 4/7 (57%) ET lambs and 5/7 (71%) IN lambs. Mean (SD) time to ROSC was 173 (32) seconds in the intravenous group, 360 (211) seconds in the ET group and 401 (175) seconds in the IN group (p<0.05 intravenous vs IN). Blood pressure and cerebral oxygen delivery were highest in the intravenous group immediately post-ROSC (p<0.05), whereas the ET group sustained the highest blood pressure over the 60-min observation (p<0.05).CONCLUSION: Our study supports neonatal resuscitation guidelines, highlighting intravenous administration as the most effective route for epinephrine. ET and IN epinephrine should only be considered when intravenous access is delayed or not feasible.PMID:39237256 | DOI:10.1136/archdischild-2024-327348… -
Umbilical cord management in newborn resuscitation: a systematic review and meta-analysis
Pediatr Res. 2024 Sep 2. doi: 10.1038/s41390-024-03496-7. Online ahead of print.ABSTRACTBACKGROUND: Evidence supporting the benefits of delayed cord clamping is increasing; however, there is no clear recommendation on cord management during newborn resuscitation. This study aimed to investigate the effects of resuscitation initiated with an intact umbilical cord, hypothesizing it is a safe stabilization procedure that improves neonatal outcomes.METHODS: Systematic search was conducted in MEDLINE, Embase, CENTRAL, and Web of Science from inception to March 1, 2024. Eligible articles compared neonatal outcomes in newborns receiving initial stabilization steps before and after cord clamping.RESULTS: Twelve studies met our inclusion criteria, with six RCTs included in the quantitative analysis. No statistically significant differences were found in delivery room parameters, in-hospital mortality, or neonatal outcomes between the examined groups. However, intact cord resuscitation group showed higher SpO2 at 5 min after birth compared to cord clamping prior to resuscitation group (MD 6.67%, 95% CI [-1.16%, 14.50%]). There were no significant differences in early complications of prematurity (NEC ≥ stage 2: RR 2.05, 95% CI [0.34, 12.30], IVH: RR 1.25, 95% CI [0.77, 2.00]).CONCLUSION: Intact cord management during resuscitation appears to be a safe intervention; its effect on early complications of prematurity remains unclear. Further high-quality RCTs with larger patient numbers are urgently needed.IMPACT: Initiating resuscitation with an intact umbilical cord appears to be a safe intervention for newborns. No statistically significant differences were found in delivery room parameters, in-hospital mortality, and neonatal outcomes between the examined groups. The utilization of specialized resuscitation trolleys appears to be promising to reduce the risk of intraventricular hemorrhage in preterm infants. Further high-quality RCTs with larger sample sizes are urgently needed to refine recommendations.PMID:39223253 | DOI:10.1038/s41390-024-03496-7… -
Detection of time of birth and cord clamping using thermal video in the delivery room
Front Pediatr. 2024 Aug 14;12:1342415. doi: 10.3389/fped.2024.1342415. eCollection 2024.ABSTRACTINTRODUCTION: Newborn resuscitation algorithms emphasize that resuscitation is time-critical, and all algorithm steps are related to the time of birth. Infrared thermal video has the potential to capture events in the delivery room, such as birth, cord clamping, and resuscitative interventions, while upholding the privacy of patients and healthcare providers.OBJECTIVES: The objectives of this concept study were to (i) investigate the technical feasibility of using thermal video in the delivery room to detect birth and cord clamping, and (ii) evaluate the accuracy of manual real-time registrations of the time of birth and cord clamping by comparing it with the accuracy of registrations abstracted from thermal videos.METHODS: An observational study with data collected at Stavanger University Hospital, Norway, from September 2022 to August 2023. The time of birth and cord clamping were manually registered on a portable tablet by healthcare providers. Thermal cameras were placed in the delivery rooms and operating theatre to capture births. Videos were retrospectively reviewed to determine the time of birth and cord clamping.RESULTS: Participation consent was obtained from 306 mothers, of which 195 births occurred in delivery rooms or an operating theatre with a thermal camera installed. We excluded 12 videos in which no births occurred. Births were detectable in all 183 (100%) thermal videos evaluated. There was a median (quartiles) of 1.8 (0.7, 5.4) s deviation in the manual registrations of the times of births relative to those abstracted from thermal videos. Cord clamping was detectable in 173 of the 183 (95%) thermal videos, with a median of 18.3 (3.3, 108) s deviation in the manual registrations of the times of cord clampings relative to those abstracted from thermal videos.CONCLUSION: Recognizing the time of birth and cord clamping from thermal videos is technically feasible and provides a method for determining when resuscitative events occur.PMID:39205665 | PMC:PMC11349661 | DOI:10.3389/fped.2024.1342415… -
Physiological-Based Cord Clamping: When the Baby Is Ready for Clamping
Neonatology. 2024;121(5):547-552. doi: 10.1159/000540667. Epub 2024 Aug 28.ABSTRACTBACKGROUND: The timing of cord clamping has become a focal point for neonatal caregivers due to the promising outcomes associated with delayed cord clamping, which is a simple and cost-effective method to enhance the survival and well-being of preterm infants. While initially the rationale behind delaying clamping was to facilitate increased placental transfusion, research has unveiled additional hemodynamic benefits.SUMMARY: Experimental studies have demonstrated improved circulatory transition when clamping is postponed until the lungs are adequately aerated. This suggests that infants requiring assistance during the transition phase may benefit from stabilization while still attached to the cord. The Aeration, Breathing, and then Clamping (ABC) project aimed to translate these experimental findings into clinical practice.KEY MESSAGE: In this review, we will discuss the insights gained and lessons learned from the project's implementation.PMID:39197438 | PMC:PMC11446291 | DOI:10.1159/000540667… -
Maternal antibiotic prophylaxis during cesarean section has a limited impact on the infant gut microbiome
Cell Host Microbe. 2024 Aug 14;32(8):1444-1454.e6. doi: 10.1016/j.chom.2024.07.010.ABSTRACTPregnant women undergoing a cesarean section (CS) typically receive antibiotics prior to skin incision to prevent infections. To investigate if the timing of antibiotics influences the infant gut microbiome, we conducted a randomized controlled trial (NCT06030713) in women delivering via a scheduled CS who received antibiotics either before skin incision or after umbilical cord clamping. We performed a longitudinal analysis on 172 samples from 28 infants at 8 post-birth time points and a cross-sectional analysis at 1 month in 79 infants from 3 cohorts. Although no significant associations with bacterial composition, metabolic pathways, short-chain fatty acids, and bile acids were found, we observed subtle differences between the groups at the bacterial strain level and in the load of antibiotic resistance genes. Rather, feeding mode was a predominant and defining factor impacting infant microbial composition. In conclusion, antibiotic administration during CS has only limited effects on the early-life gut microbiome.PMID:39146801 | PMC:PMC11335186 | DOI:10.1016/j.chom.2024.07.010… -
The application of cut-umbilical cord milking in term cesarean deliveries for preventing anemia and iron deficiency of newborns
Zhonghua Yi Xue Za Zhi. 2024 Aug 20;104(32):3042-3049. doi: 10.3760/cma.j.cn112137-20240621-01378.ABSTRACTObjective: To anlysis the efficacy and safety of cut-umbilical cord milking (C-UCM) compared with immediate cord clamping in preventing anemia and iron deficiency among term cesarean-delivered newborns. Methods: A total of 485 pregnant women planning to deliver by cesarean section were recruited in this randomized controlled trial in Hunan Maternal and Child Health Hospital and Liuyang Maternal and Child Health Care Hospital from July 2016 to April 2019. A block randomization was conducted to evenly allocate them to the controlled group and the C-UCM group. In the controlled group, the cord was clamped within 30 seconds as routine. In the C-UCM group, the cord was first clamped at 25 cm from the newborn's navel, and then the blood in the cord was gently squeezed into the newborn's body until the cord became white and shriveled. The cord was clamped twice at 2-3 cm from the newborn's navel subsequently. Neonatal jaundice, hyperbilirubinemia and polycythemia were monitored before discharge. After the newborns discharged, their hemoglobin, red blood cell count, hematocrit (at the age of 1, 6 and 12 months) and serum ferritin (at the age of 6 and 12 months) were followed up; body length and weight were measured; and information about their feeding and iron supplementation were collected (at the age of 1, 6, 12 and 18 months). The two groups were compared by t test, Mann-Whitney U test, χ² test, or Fisher exact probability method. The hospital was set as a random item, and the mixed effects regression model was used to evaluate the effect of C-UCM on relevant indicators of cesarean-delivered newborns. Results: There were 244 women in the C-UCM group with an average age of (31.9±4.4) years, and 241 in the control group with an average age of (31.8±4.2) years (P>0.05). There was no statistically significant difference between the C-UCM group and the control group at 1, 6 and 12 months of age in hemoglobin [(123.6±14.5) vs (122.2±14.5) g/L, (115.3±9.4) vs (114.1±8.5) g/L, (115.6±9.6) vs (116.1±12.6) g/L] or anemia incidence rate [15.2% (17/112) vs 18.4% (19/103), 22.7% (34/150) vs 26.8% (44/164), 22.3% (25/112) vs 19.5% (22/113)] (all P>0.05). There was no statistically significant difference between the two groups at 6 and 12 months of age in serum ferritin [M (Q1, Q3), 39.9 (24.9, 61.8) vs 43.6 (25.2, 100.9) μg/L, 40.3 (25.4, 259.2) vs 40.3 (26.4, 167.6) μg/L)] or iron deficiency incidence rate [6.1% (5/82) vs 4.2% (3/72), 6.7% (5/75) vs 3.8% (3/80)] (all P>0.05). There were also no significant difference between the two groups in other indicators, such as the Z-score of weight-for-length, the incidence of neonatal jaundice, and the incidence of neonatal hyperbilirubinemia (all P>0.05). After adjusting for the relevant covariates, there were still no significant effects of C-UCM on these outcomes above. Conclusions: Compared to immediate cord clamping, the intervention of gently squeezing 25 cm of the cord does not significantly reduce the risk of anemia or iron deficiency in term cesarean-delivered newborns, nor does it have a significant impact on infant growth and development. Yet this intervention does not increase the risk of jaundice or hyperbilirubinemia in newborns as well.PMID:39143772 | DOI:10.3760/cma.j.cn112137-20240621-01378… -
How to improve newborn outcomes in 60 s-delay clamping the umbilical cord
BMC Pregnancy Childbirth. 2024 Aug 14;24(1):534. doi: 10.1186/s12884-024-06467-2.ABSTRACTDeferred umbilical cord clamping (DCC) has been employed with wide variation in the United States over the last few decades. This practice has the potential to improve infant health and outcomes at the population health level. Education campaigns and policy interventions can promote DCC use in a safe manner.PMID:39143565 | PMC:PMC11323698 | DOI:10.1186/s12884-024-06467-2… -
Delaying cord clamping for more than 1 minute after vaginal deliveries appeared to result in smoother cardiocirculatory transition
Acta Paediatr. 2024 Nov;113(11):2411-2413. doi: 10.1111/apa.17373. Epub 2024 Aug 5.NO ABSTRACTPMID:39101781 | DOI:10.1111/apa.17373… -
Early or delayed cord clamping during transition of term newborns: does it make any difference in cerebral tissue oxygenation?
Ital J Pediatr. 2024 Jul 29;50(1):133. doi: 10.1186/s13052-024-01707-9.ABSTRACTBACKGROUND: According to the World Health Organization's recommendation, delayed cord clamping in term newborns can have various benefits. Cochrane metaanalyses reported no differences for mortality and early neonatal morbidity although a limited number of studies investigated long-term neurodevelopmental outcomes. The aim of our study is to compare the postnatal cerebral tissue oxygenation values in babies with early versus delayed cord clamping born after elective cesarean section.METHODS: In this study, a total of 80 term newborns delivered by elective cesarean section were included. Infants were randomly grouped as early (clamped within 15 s, n:40) and delayed cord clamping (at the 60th second, n:40) groups. Peripheral arterial oxygen saturation (SpO2) and heart rate were measured by pulse oximetry while regional oxygen saturation of the brain (rSO2) was measured with near-infrared spectrometer. Fractional tissue oxygen extraction (FTOE) was calculated for every minute between the 3rd and 15th minute after birth. (FTOE = pulse oximetry value-rSO2/pulse oximetry value). The measurements were compared for both groups.RESULTS: The demographical characteristics, SpO2 levels (except postnatal 6th, 8th, and 14th minutes favoring DCC p < 0.05), heart rates and umbilical cord blood gas values were not significantly different between the groups (p > 0.05). rSO2 values were significantly higher while FTOE values were significantly lower for every minute between the 3rd and 15th minutes after birth in the delayed cord clamping group (p < 0.05).CONCLUSION: Our study revealed a significant increase in cerebral rsO2 values and a decrease in FTOE values in the delayed cord clamping (DCC) group, indicating a positive impact on cerebral oxygenation and hemodynamics. Furthermore, the DCC group exhibited a higher proportion of infants with cerebral rSO2 levels above the 90th percentile. This higher proportion, along with a lower of those with such parameter below the 10th percentile, suggest that DCC may lead to the targeted/optimal cerebral oxygenetaion of these babies. As a result, we recommend measuring cerebral oxygenation, in addition to peripheral SpO2, for infants experiencing perinatal hypoxia and receiving supplemental oxygen.PMID:39075594 | PMC:PMC11288115 | DOI:10.1186/s13052-024-01707-9… -
Extended period of ventilation before umbilical cord clamping at birth: A study that mis-interprets and mis-represents the physiology
J Physiol. 2024 Sep;602(17):4327-4328. doi: 10.1113/JP286866. Epub 2024 Jul 15.NO ABSTRACTPMID:39008340 | DOI:10.1113/JP286866… -
Safety of different cord clamping strategies in the early postnatal period
Early Hum Dev. 2024 Aug;195:106075. doi: 10.1016/j.earlhumdev.2024.106075. Epub 2024 Jul 10.ABSTRACTBACKGROUND: This study aimed to evaluate the effect of ICC (cord clamping within the first 15 s), DCC (delayed cord clamping at 60 s), and cut-UCM (cut-umbilical cord milking, cord clamping within the first 15 s) groups on oxygen saturation (SpO2), heart rate (HR), and perfusion index (PI) up to 10 min after birth in newborn infants.METHODS: We conducted this randomized clinical trial in the delivery unit of a University Hospital with 189 infants born between 35 and 42 weeks of gestation. Participants were randomly assigned to one of three groups: ICC, DCC, and cut-UCM. The primary outcomes measured were SpO2, HR, and PI at the 1st, 3rd, 5th, and 10th minutes after birth. We utilized ANOVA and Bayesian calculations in this study.RESULTS: There was no difference between the ICC, DCC, and cut-UCM groups in SpO2, HR, and PI values at the 1st, 3rd, 5th, and 10th minutes of life, which did not significantly alter between the three groups in one-way ANOVA. Bayesian repeated-measure ANOVA calculations showed that SpO2 and heart rate results at the 1st, 3rd, 5th, and 10th minutes did not differ between ICC, DCC, and cut-UCM techniques with strong evidence. At the 3rd minute, PI was slightly higher in the DCC and cut-UCM groups compared to the ICC group, with anecdotal evidence. We found no difference between DCC and cut-UCM regarding the 3rd-minute PI, with moderate evidence.CONCLUSION: Umbilical clamping procedures (ICC, DCC, and cut-UCM) did not affect SpO2 and HR in the first ten minutes of life, but 3rd-minute PI values were slightly higher in DCC and cut-UCM compared with ICC among late preterm and term neonates.PMID:39002384 | DOI:10.1016/j.earlhumdev.2024.106075… -
Bacterial species in cord blood and their significance in the context of clinical use
Transfus Apher Sci. 2024 Aug;63(4):103961. doi: 10.1016/j.transci.2024.103961. Epub 2024 Jun 29.ABSTRACTApproximately 90 % of infants born before 28 full weeks(extremely-preterm-infants) receive erythrocyte transfusions in early life. Umbilical cord blood(UCB) has been investigated as an alternative source for erythrocyte transfusions to preterm neonates. This retrospective study aimed to compile/evaluate spectrum of bacteria groups/species intermittently detected in processed UCB at National-Swedish-Cord blood bank, (NS-CBB) during the years 2008-2020. Consecutive data from the years 2008-2020 were investigated. UCB from healthy newborns born after 37 full weeks of gestation was collected following clamping of cord (1 min) through cannulation of umbilical vein(vaginal-and C-section-deliveries). In total, 5194 cord blood units (UCBUs) that met NS-CBB-guidelines for total nucleated-cell-content(TNC) were manufactured from 8875 collections. Of 5194 UCBUs,77,6 % were from vaginal-and 22,4 % from C-section deliveries.Samples(10 mL) were collected from surplus eryhtrocyte fraction post-processing(n = 5194), transferred into BACT/ALERT® aerobic/anaerobic culture flasks and monitored 10 days using BACT/ALERT®-3D-Microbial-Detection-Systems. Positive samples were subcultured and typed for bacterial groups and/or species. Out of 5194 processed sampled UCB units,186 (3,6 %) were discarded due to positive sterility tests, 92 % were detected in samples from vaginal-deliveries and 8 % from C-section-deliveries. In all,16 different groups of bacteria and 27 species were identified. Common bacterial/groups and species were anaerobe gram-negative rods(n = 28),coagulase-negative-staphylococci(n = 21),gram-positive rods(n = 21),anaerobe-gram-positive cocci(n = 20) and viridans-streptococci(n = 13). Extracted from these results,in positive samples(n = 13) from C-section deliveries, bacteria were found:viridans-streptococci(n = 7),Aerococcus-urinae(n = 1), Staphylococcus lugdunensis(n = 1),other coagulase-negative staphylococci(n = 1) or a mix of aerobic/anaerobic bacteria(n = 3). Our results are in alignment with previously published contamination rates in processed UCBUs. Still, results point towards importance of strict microbial monitoring when manufacturing UCBUs to achieve patient-safe- products for stem-cell transplantation/transfusion.PMID:38981148 | DOI:10.1016/j.transci.2024.103961… -
Cord Obstruction and Delayed Cord Clamping Do Not Affect Gut Function in Neonatal Piglets
Neonatology. 2025;122(1):66-75. doi: 10.1159/000539527. Epub 2024 Jun 28.ABSTRACTINTRODUCTION: Birth-related obstruction of umbilical blood flow may induce hypoxic insults that affect postnatal organ adaptation. Using newborn cesarean-delivered pigs, we hypothesized that cord obstruction during delivery negatively affects physiological transition and gut maturation. Further, we investigated if delayed cord clamping (DCC) improves gut outcomes, including sensitivity to formula-induced necrotizing enterocolitis (NEC)-like lesions.METHODS: In experiment 1, preterm (n = 24) and near-term (n = 29) piglets were subjected to umbilical cord obstruction (UCO, 5-7 min in utero), with corresponding pigs delivered without obstruction (CON, n = 17-22). Experiment 2 assessed preterm pigs subjected to delayed cord clamping (n = 30, 60 s) or immediate cord transection with umbilical cord milking (UCM, n = 34). Postnatal vital parameters were recorded, together with a series of gut parameters after 3 days of formula feeding.RESULTS: UCO induced respiratory-metabolic acidosis in near-term pigs at birth (pH 7.16 vs. 7.32, pCO2 12.5 vs. 9.2 kPa, lactate 5.2 vs. 2.5 mmol/L, p < 0.05). In preterm pigs, UCO increased failure of resuscitation and mortality shortly after birth (88 vs. 47%, p < 0.05). UCO did not affect gut permeability, transit time, macromolecule absorption, six digestive enzymes, or sensitivity to NEC-like lesions. In experiment 2, DCC improved neonatal hemodynamics (pH 7.28 vs. 7.20, pCO2 8.9 vs. 9.9 at 2 h, p < 0.05), with no effects on gut parameters.CONCLUSION: UCO and DCC affect neonatal transition and hemodynamics, but not neonatal gut adaptation or sensitivity to NEC-like lesions. Our findings suggest that the immature newborn gut is highly resilient to transient birth-related changes in cord blood flow.PMID:38952138 | DOI:10.1159/000539527… -
Two-Year Outcomes of Umbilical Cord Milking in Nonvigorous Infants: A Secondary Analysis of the MINVI Randomized Clinical Trial
JAMA Netw Open. 2024 Jul 1;7(7):e2416870. doi: 10.1001/jamanetworkopen.2024.16870.ABSTRACTIMPORTANCE: Compared with early cord clamping (ECC), umbilical cord milking (UCM) reduces delivery room cardiorespiratory support, hypoxic-ischemic encephalopathy, and therapeutic hypothermia in nonvigorous near-term and full-term infants. However, UCM postdischarge outcomes are not known.OBJECTIVE: To determine the 2-year outcomes of children randomized to UCM or ECC at birth in the Milking in Nonvigorous Infants (MINVI) trial.DESIGN, SETTING, AND PARTICIPANTS: A secondary analysis to evaluate longer-term outcomes of a cluster-randomized crossover trial was conducted from January 9, 2021, to September 25, 2023. The primary trial took place in 10 medical centers in the US, Canada, and Poland from January 5, 2019, to June 1, 2021, and hypothesized that UCM would reduce admission to the neonatal intensive care unit compared with ECC; follow-up concluded September 26, 2023. The population included near-term and full-term infants aged 35 to 42 weeks' gestation at birth who were nonvigorous; families provided consent to complete developmental screening questionnaires through age 2 years.INTERVENTION: UCM and ECC.MAIN OUTCOMES AND MEASURES: Ages and Stages Questionnaire, 3rd Edition (ASQ-3) and Modified Checklist for Autism in Toddlers, Revised/Follow-Up (M-CHAT-R/F) questionnaires at ages 22 to 26 months. Intention-to-treat analysis and per-protocol analyses were used.RESULTS: Among 1730 newborns from the primary trial, long-term outcomes were evaluated in 971 children (81%) who had ASQ-3 scores available at 2 years or died before age 2 years and 927 children (77%) who had M-CHAT-R/F scores or died before age 2 years. Maternal and neonatal characteristics by treatment group were similar, with median birth gestational age of 39 (IQR, 38-40) weeks in both groups; 224 infants (45%) in the UCM group and 201 (43%) in the ECC group were female. The median ASQ-3 total scores were similar (UCM: 255 [IQR, 225-280] vs ECC: 255 [IQR, 230-280]; P = .87), with no significant differences in the ASQ-3 subdomains. Medium- to high-risk M-CHAT-R/F scores were also similar (UCM, 9% [45 of 486] vs ECC, 8% [37 of 441]; P = .86).CONCLUSIONS AND RELEVANCE: In this secondary analysis of a randomized clinical trial among late near-term and full-term infants who were nonvigorous at birth, ASQ-3 scores at age 2 years were not significantly different between the UCM and ECC groups. Combined with previously reported important short-term benefits, this follow-up study suggests UCM is a feasible, no-cost intervention without longer-term neurodevelopmental risks of cord milking in nonvigorous near-term and term newborns.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03631940.PMID:38949814 | PMC:PMC11217871 | DOI:10.1001/jamanetworkopen.2024.16870… -
Pregnancy Outcomes of Nifedipine Compared With Labetalol for Oral Treatment of Mild Chronic Hypertension
Obstet Gynecol. 2024 Jul 1;144(1):126-134. doi: 10.1097/AOG.0000000000005613. Epub 2024 May 23.ABSTRACTOBJECTIVE: To evaluate maternal and neonatal outcomes by type of antihypertensive used in participants of the CHAP (Chronic Hypertension in Pregnancy) trial.METHODS: We conducted a planned secondary analysis of CHAP, an open-label, multicenter, randomized trial of antihypertensive treatment compared with standard care (no treatment unless severe hypertension developed) in pregnant patients with mild chronic hypertension (blood pressure 140-159/90-104 mm Hg before 20 weeks of gestation) and singleton pregnancies. We performed three comparisons based on medications prescribed at enrollment: labetalol compared with standard care, nifedipine compared with standard care, and labetalol compared with nifedipine. Although active compared with standard care groups were randomized, medication assignment within the active treatment group was not random but based on clinician or patient preference. The primary outcome was the occurrence of superimposed preeclampsia with severe features, preterm birth before 35 weeks of gestation, placental abruption, or fetal or neonatal death. The key secondary outcome was small for gestational age (SGA) neonates. We also compared medication adverse effects between groups. Relative risks (RRs) and 95% CIs were estimated with log binomial regression to adjust for confounding.RESULTS: Of 2,292 participants analyzed, 720 (31.4%) received labetalol, 417 (18.2%) received nifedipine, and 1,155 (50.4%) received no treatment. The mean gestational age at enrollment was 10.5±3.7 weeks; nearly half of participants (47.5%) identified as non-Hispanic Black; and 44.5% used aspirin. The primary outcome occurred in 217 (30.1%), 130 (31.2%), and 427 (37.0%) in the labetalol, nifedipine, and standard care groups, respectively. Risk of the primary outcome was lower among those receiving treatment (labetalol use vs standard adjusted RR 0.82, 95% CI, 0.72-0.94; nifedipine use vs standard adjusted RR 0.84, 95% CI, 0.71-0.99), but there was no significant difference in risk when labetalol was compared with nifedipine (adjusted RR 0.98, 95% CI, 0.82-1.18). There were no significant differences in SGA or serious adverse events between participants receiving labetalol and those receiving nifedipine.CONCLUSION: No significant differences in predetermined maternal or neonatal outcomes were detected on the basis of the use of labetalol or nifedipine for treatment of chronic hypertension in pregnancy.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT02299414.PMID:38949541 | PMC:PMC11219006 | DOI:10.1097/AOG.0000000000005613… -
Management of Spontaneous Vaginal Delivery
Am Fam Physician. 2024 Jun;109(6):525-532.ABSTRACTPregnancy dating is determined by the patient's last menstrual period or an ultrasound measurement. A full-term pregnancy is considered 37 weeks' gestation or more. Spontaneous labor begins when regular painful uterine contractions result in a cervical change. Active labor begins at 6 cm dilation and is marked by more predictable, accelerated cervical change. In the absence of pregnancy complications, intermittent fetal auscultation may be considered as an alternative to continuous electronic fetal monitoring, which is associated with a high false-positive rate. Intravenous antibiotic prophylaxis is indicated in patients with group B streptococcus colonization or those at high risk to prevent newborn early-onset group B streptococcus. The likelihood of vaginal delivery is increased by providing continuous nonmedical support during labor, encouraging mobility, and using a peanut ball with epidural analgesia. Neuraxial analgesia is more effective for pain control than systemic opioids and is associated with fewer adverse effects. Delayed pushing during the second stage of labor has risks but does not affect the mode of delivery. Routine oropharyngeal suctioning of the newborn is not recommended, even with meconium-stained amniotic fluid. Delayed cord clamping reduces newborn anemia. Prevention of postpartum hemorrhage in patients at risk includes prophylactic uterotonic administration and controlled cord traction. Perineal lacerations that alter anatomy or are not hemostatic should be repaired. (Am Fam Physician. 2024;109(6):525-532.PMID:38905550… -
Impact of early versus delayed umbilical cord clamping on term neonates' haemoglobin levels: a randomized controlled trial
J Int Med Res. 2024 Jun;52(6):3000605241255836. doi: 10.1177/03000605241255836.ABSTRACTOBJECTIVE: To compare the effects of early and delayed cord clamping on the haemoglobin levels of neonates delivered at term.METHODS: This randomized controlled trial enrolled pregnant women during the second stage of labour. They were randomized into either the early cord clamping (ECC) group or the delayed cord clamping (DCC) group in the ratio of 1:1. Following delivery of the baby, the umbilical cords of participants in the ECC group were clamped within 30 s of delivery of the neonate while those of participants in the DCC group were clamped after 2 min from the delivery of the neonate. The primary outcome measure was the effect of ECC and DCC on the haemoglobin levels of neonates delivered at term.RESULTS: A total of 270 pregnant women were enrolled in the study. Their baseline sociodemographic and clinical characteristics were similar in both groups. There was no significant difference in the mean haemoglobin level between ECC and DCC groups at birth. The mean haemoglobin level of the neonates at 48 h postpartum was significantly higher in the DCC group than the ECC group.CONCLUSION: DCC at birth was associated with a significant increase in neonatal haemoglobin levels at 48 h postpartum when compared with ECC.Trial Registration: The trial was registered at Pan African Clinical Trial Registry with approval number PACTR202206735622089.PMID:38851870 | PMC:PMC11162598 | DOI:10.1177/03000605241255836… -
Comparison of Three Methods of Umbilical Cord Management in Late Preterm and Term Newborns on Hemoglobin and Ferritin Levels at Six Weeks of Age: A Randomized Controlled Trial
Cureus. 2024 Apr 26;16(4):e59046. doi: 10.7759/cureus.59046. eCollection 2024 Apr.ABSTRACTBACKGROUND: Umbilical cord milking (UCM) and delayed cord clamping (DCC) are strategies that improve the hemodynamic condition of the newborn and also increase the storage of iron. This study aimed to compare the effects of DCC with or without milking in late preterm and term neonates at different time intervals after birth (60, 120, and 180 seconds) on hematological and hemodynamic parameters in neonates at six weeks of age.MATERIALS AND METHODS: In this double-arm, parallel-group, triple-blind, and active-controlled trial, all 150 eligible neonates were randomized with allocation concealment into three groups: Group A (DCC with UCM at 60 seconds), Group B (DCC with UCM at 120 seconds), and Group C (only DCC for 180 seconds). Hemodynamic parameters were recorded and compared during the first 48 hours, and hematological parameters were compared at six weeks of age.RESULTS: At six weeks, a significant difference in hemoglobin levels was noted between Groups A, B, and C (p<0.001). The difference in serum ferritin values at six weeks was also statistically significant in comparisons across all three groups (p=0.003). Regarding secondary outcomes examined, hemodynamic parameters and the incidence of neonatal hyperbilirubinemia were found to be comparable at 48 hours after birth.CONCLUSION: DCC followed by UCM at 120 seconds and DCC till 180 seconds proves superior to DCC with UCM at 60 seconds in preserving elevated hemoglobin levels and iron stores in neonates at six weeks of age. DCC for 180 seconds yielded comparable results, followed by UCM at 120 seconds. All three methods are considered safe and effective without compromising the neonate's hemodynamics.PMID:38800297 | PMC:PMC11128072 | DOI:10.7759/cureus.59046… -
Metabolomic profiles of preterm small-for-gestational age infants
Pediatr Neonatol. 2025 Jan;66(1):50-54. doi: 10.1016/j.pedneo.2023.11.012. Epub 2024 May 20.ABSTRACTWe aimed to characterize the metabolomic profiles in preterm small-for-gestational age (SGA) infants using cord blood. We conducted a gestational age (GA)-matched case-control study that included 30 preterm infants who were categorized into two groups: SGA infants, with a birth weight (BW) < 10th percentile for GA (n = 15) and non-SGA infants, with BW ≥ 10th percentile for GA (n = 15). SGA infants with chromosomal or genetic abnormalities were excluded. At birth, the umbilicus was double-clamped, and the cord blood was sampled from the umbilical vein. Metabolomic analyses were performed using capillary electrophoresis time-of-flight mass spectrometry. The median GA at birth was not significantly different between the two groups [SGA, 32 (26-36) weeks; non-SGA, 32 (25-35) weeks; p = 0.661)]. Of the 255 metabolites analyzed, 19 (7.5%) showed significant differences between SGA and non-SGA infants. There were significant reductions in the carnosine, hypotaurine, and S-methylcysteine levels in SGA infants as compared to non-SGA infants (p < 0.05). Carnosine was correlated with gestational age, BMI before pregnancy, body weight gain during pregnancy (p = 0.002, p = 0.023, and p = 0.020, respectively). In conclusion, preterm SGA infants have low levels of cord blood antioxidative- and antiglycation-related metabolites, making them vulnerable to oxidative stress.PMID:38789293 | DOI:10.1016/j.pedneo.2023.11.012… -
Mean Arterial Pressure and Neonatal Outcomes in Pregnancies Complicated by Mild Chronic Hypertension
Obstet Gynecol. 2024 Jul 1;144(1):101-108. doi: 10.1097/AOG.0000000000005611. Epub 2024 May 23.ABSTRACTOBJECTIVE: To estimate the association between mean arterial pressure during pregnancy and neonatal outcomes in participants with chronic hypertension using data from the CHAP (Chronic Hypertension and Pregnancy) trial.METHODS: A secondary analysis of the CHAP trial, an open-label, multicenter randomized trial of antihypertensive treatment in pregnancy, was conducted. The CHAP trial enrolled participants with mild chronic hypertension (blood pressure [BP] 140-159/90-104 mm Hg) and singleton pregnancies less than 23 weeks of gestation, randomizing them to active treatment (maintained on antihypertensive therapy with a goal BP below 140/90 mm Hg) or standard treatment (control; antihypertensives withheld unless BP reached 160 mm Hg systolic BP or higher or 105 mm Hg diastolic BP or higher). We used logistic regression to measure the strength of association between mean arterial pressure (average and highest across study visits) and to select neonatal outcomes. Unadjusted and adjusted odds ratios (per 1-unit increase in millimeters of mercury) of the primary neonatal composite outcome (bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, or intraventricular hemorrhage grade 3 or 4) and individual secondary outcomes (neonatal intensive care unit admission [NICU], low birth weight [LBW] below 2,500 g, and small for gestational age [SGA]) were calculated.RESULTS: A total of 2,284 participants were included: 1,155 active and 1,129 control. Adjusted models controlling for randomization group demonstrated that increasing average mean arterial pressure per millimeter of mercury was associated with an increase in each neonatal outcome examined except NEC, specifically neonatal composite (adjusted odds ratio [aOR] 1.12, 95% CI, 1.09-1.16), NICU admission (aOR 1.07, 95% CI, 1.06-1.08), LBW (aOR 1.12, 95% CI, 1.11-1.14), SGA below the fifth percentile (aOR 1.03, 95% CI, 1.01-1.06), and SGA below the 10th percentile (aOR 1.02, 95% CI, 1.01-1.04). Models using the highest mean arterial pressure as opposed to average mean arterial pressure also demonstrated consistent associations.CONCLUSION: Increasing mean arterial pressure was positively associated with most adverse neonatal outcomes except NEC. Given that the relationship between mean arterial pressure and adverse pregnancy outcomes may not be consistent at all mean arterial pressure levels, future work should attempt to further elucidate whether there is an absolute threshold or relative change in mean arterial pressure at which fetal benefits are optimized along with maternal benefits.CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov , NCT02299414.PMID:38781591 | PMC:PMC11216857 | DOI:10.1097/AOG.0000000000005611… -
Survival and unique clinical practices of extremely preterm infants born at 22-23 weeks' gestation in Japan: a national survey
Arch Dis Child Fetal Neonatal Ed. 2024 Dec 20;110(1):17-22. doi: 10.1136/archdischild-2023-326355.ABSTRACTOBJECTIVES: To investigate prognosis and clinical practices of infants born at 22-23 weeks' gestational age (wkGA) in Japan.DESIGN: A national institutional-level electronic questionnaire surveys performed in September 2021.SETTING: All perinatal centres across Japan.PATIENTS: Infants born at 22-23 wkGA in 2018-2020.MAIN OUTCOME MEASURES: Proportion of active resuscitation and survival at neonatal intensive care unit (NICU) discharge, and various clinical practices.RESULTS: In total, 255 of 295 NICUs (86%) responded. Among them, 145 took care of infants born at 22-23 wkGA and answered the questions regarding their outcomes and care. In most NICUs (129 of 145 (89%)), infants born at 22+0 wkGA can be actively resuscitated. In almost half of the NICUs (79 of 145 (54%)), infants born at ≥22+0 wkGA were always actively resuscitated. Among 341 and 757 infants born alive at 22 and 23 wkGA, respectively, 85% (291 of 341) and 98% (745 of 757) received active resuscitation after birth. Among infants actively resuscitated at birth, 63% (183 of 291) and 80% (594 of 745) of infants born at 22 and 23 wkGA survived, respectively. The survey revealed unique clinical management for these infants in Japan, including delivery with caul in caesarean section, cut-cord milking after clamping cord, immediate intubation at birth, hydrocortisone use for chronic lung disease, analgesia/sedation use for infants on mechanical ventilation, routine echocardiography and brain ultrasound, probiotics administration, routine glycerin enema and skin dressing to prevent pressure ulcers.CONCLUSIONS: Many 22-23 wkGA infants were actively resuscitated in Japan and had a high survival rate. Various unique clinical practices were highlighted.PMID:38777561 | DOI:10.1136/archdischild-2023-326355… -
Measuring direct effect of cord clamping approaches: getting the right target group
Pediatr Res. 2024 Jul;96(1):5-6. doi: 10.1038/s41390-024-03284-3. Epub 2024 May 20.NO ABSTRACTPMID:38769402 | DOI:10.1038/s41390-024-03284-3… -
Ventilatory Assistance Before Umbilical Cord Clamping in Extremely Preterm Infants: A Randomized Clinical Trial
JAMA Netw Open. 2024 May 1;7(5):e2411140. doi: 10.1001/jamanetworkopen.2024.11140.ABSTRACTIMPORTANCE: Providing assisted ventilation during delayed umbilical cord clamping may improve outcomes for extremely preterm infants.OBJECTIVE: To determine whether assisted ventilation in extremely preterm infants (23 0/7 to 28 6/7 weeks' gestational age [GA]) followed by cord clamping reduces intraventricular hemorrhage (IVH) or early death.DESIGN, SETTING, AND PARTICIPANTS: This phase 3, 1:1, parallel-stratified randomized clinical trial conducted at 12 perinatal centers across the US and Canada from September 2, 2016, through February 21, 2023, assessed IVH and early death outcomes of extremely preterm infants randomized to receive 120 seconds of assisted ventilation followed by cord clamping vs delayed cord clamping for 30 to 60 seconds with ventilatory assistance afterward. Two analysis cohorts, not breathing well and breathing well, were specified a priori based on assessment of breathing 30 seconds after birth.INTERVENTION: After birth, all infants received stimulation and suctioning if needed. From 30 to 120 seconds, infants randomized to the intervention received continuous positive airway pressure if breathing well or positive-pressure ventilation if not, with cord clamping at 120 seconds. Control infants received 30 to 60 seconds of delayed cord clamping followed by standard resuscitation.MAIN OUTCOMES AND MEASURES: The primary outcome was any grade IVH on head ultrasonography or death before day 7. Interpretation by site radiologists was confirmed by independent radiologists, all masked to study group. To estimate the association between study group and outcome, data were analyzed using the stratified Cochran-Mantel-Haenszel test for relative risk (RR), with associations summarized by point estimates and 95% CIs.RESULTS: Of 1110 women who consented to participate, 548 were randomized and delivered infants at GA less than 29 weeks. A total of 570 eligible infants were enrolled (median [IQR] GA, 26.6 [24.9-27.7] weeks; 297 male [52.1%]). Intraventricular hemorrhage or death occurred in 34.9% (97 of 278) of infants in the intervention group and 32.5% (95 of 292) in the control group (adjusted RR, 1.02; 95% CI, 0.81-1.27). In the prespecified not-breathing-well cohort (47.5% [271 of 570]; median [IQR] GA, 26.0 [24.7-27.4] weeks; 152 male [56.1%]), IVH or death occurred in 38.7% (58 of 150) of infants in the intervention group and 43.0% (52 of 121) in the control group (RR, 0.91; 95% CI, 0.68-1.21). There was no evidence of differences in death, severe brain injury, or major morbidities between the intervention and control groups in either breathing cohort.CONCLUSIONS AND RELEVANCE: This study did not show that providing assisted ventilation before cord clamping in extremely preterm infants reduces IVH or early death. Additional study around the feasibility, safety, and efficacy of assisted ventilation before cord clamping may provide additional insight.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02742454.PMID:38758557 | PMC:PMC11102017 | DOI:10.1001/jamanetworkopen.2024.11140… -
Effect of administration routes of oxytocin on hemoglobin in neonates with delayed umbilical cord clamping: a multi-centre randomized controlled clinical trial
Arch Gynecol Obstet. 2024 Aug;310(2):991-999. doi: 10.1007/s00404-024-07543-w. Epub 2024 May 16.ABSTRACTPURPOSE: To evaluate the effect of intravenous infusion versus intramyometrial injection of oxytocin on hemoglobin levels in neonates with delayed umbilical cord clamping during cesarean section.METHODS: The multi-centre randomized controlled trial was performed at three hospitals from February to June 2023. Women with term singleton gestations scheduled for cesarean delivery were allocated to receive an intravenous infusion of 10 units of oxytocin or a myometrial injection of 10 units of oxytocin during the surgery. The primary outcome was neonatal hemoglobin at 48 to 96 h after birth. Secondary outcomes were side-effects of oxytocin, postpartum haemorrhage, phototherapy for jaundice, feeding at 1 month, maternal and neonatal morbidity and re-admissions.RESULTS: A total of 360 women were randomized (180 women in each group). The mean neonatal hemoglobin did not show a significant difference between the intravenous infusion group (194.3 ± 21.7 g/L) and the intramyometrial groups (195.2 ± 24.3 g/L) (p = 0.715). Secondary neonatal outcomes, involving phototherapy for jaundice, feeding at 1 month and neonatal intensive care unit admission were similar between the two groups. The maternal outcomes did not differ significantly between the two groups, except for a 200 mL higher intraoperative infusion volume observed in the intravenous group compared to the intramyometrial group.CONCLUSION: Among women undergoing elective cesarean delivery of term singleton pregnancies, there was no significant difference in neonatal hemoglobin at 48 to 96 h after birth between infants with delayed cord clamping, whether the oxytocin was administrated by intravenous infusion or intramyometrial injection.TRIAL REGISTRATION: Chinese Clinical trial registry: ChiCTR2300067953 (1 February 2023).PMID:38753205 | PMC:PMC11258157 | DOI:10.1007/s00404-024-07543-w… -
Neonatal Resuscitation Practices in Portuguese Delivery Rooms: A Cross-Sectional Study
Acta Med Port. 2024 May 2;37(5):342-354. doi: 10.20344/amp.20009. Epub 2024 May 2.ABSTRACTINTRODUCTION: Data from previous studies have demonstrated inconsistency between current evidence and delivery room resuscitation practices in developed countries. The primary aim of this study was to assess the quality of newborn healthcare and resuscitation practices in Portuguese delivery rooms, comparing current practices with the 2021 European Resuscitation Council guidelines. The secondary aim was to compare the consistency of practices between tertiary and non-tertiary centers across Portugal.METHODS: An 87-question survey concerning neonatal care was sent to all physicians registered with the Portuguese Neonatal Society via email. In order to compare practices between centers, participants were divided into two groups: Group A (level III and level IIb centers) and Group B (level IIa and I centers). A descriptive analysis of variables was performed in order to compare the two groups.RESULTS: In total, 130 physicians responded to the survey. Group A included 91 (70%) and Group B 39 (30%) respondents. More than 80% of participants reported the presence of a healthcare professional with basic newborn resuscitation training in all deliveries, essential equipment in the delivery room, such as a resuscitator with a light and heat source, a pulse oximeter, and an O2 blender, and performing delayed cord clamping for all neonates born without complications. Less than 60% reported performing team briefing before deliveries, the presence of electrocardiogram sensors, end-tidal CO2 detector, and continuous positive airway pressure in the delivery room, and monitoring the neonate's temperature. Major differences between groups were found regarding staff attending deliveries, education, equipment, thermal control, umbilical cord management, vital signs monitoring, prophylactic surfactant administration, and the neonate's transportation out of the delivery room.CONCLUSION: Overall, adherence to neonatal resuscitation international guidelines was high among Portuguese physicians. However, differences between guidelines and current practices, as well as between centers with different levels of care, were identified. Areas for improvement include team briefing, ethics, education, available equipment in delivery rooms, temperature control, and airway management. The authors emphasize the importance of continuous education to ensure compliance with the most recent guidelines and ultimately improve neonatal health outcomes.PMID:38744237 | DOI:10.20344/amp.20009… -
Newborns at risk of COVID-19, the story continues
J Perinat Med. 2024 May 15;52(6):567-574. doi: 10.1515/jpm-2024-0125. Print 2024 Jul 26.ABSTRACTAfter more than 4 years of the SARS-CoV-2 pandemic, a great deal of knowledge on how this virus affects pregnant women, the fetus and the newborn has accumulated. Guidelines for mode of delivery, cord clamping, skin to skin, breastfeeding, and rooming-in have become uniform across the world. Vaccination has considerably improved outcomes, but hesitancy amongst pregnant patients and the emergence of variants remain challenged and SARS-CoV-2 positivity during pregnancy continues to be associated with an increased risk of maternal complications, premature delivery and higher neonatal mortality and morbidity. An emerging body of data now exists on the effect of SARS-CoV-2 in pregnancy on early neonatal outcomes, medical education in obstetrics and pediatrics, and longer-term developmental outcomes. In this article, we review the development in this field since our last review.PMID:38742624 | DOI:10.1515/jpm-2024-0125… -
Effect of Delayed Cord Clamping on Breastfeeding Behaviors During the First Breastfeed: A Randomized Controlled Study
Breastfeed Med. 2024 Aug;19(8):624-628. doi: 10.1089/bfm.2024.0080. Epub 2024 May 13.ABSTRACTObjective: Delayed cord clamping (DCC) may increase the success of breastfeeding by improving neurological and cardiovascular function in neonates. In this study, we investigated the impact of DCC on breastfeeding behaviors, neonatal activity status, and maternal satisfaction during the first breastfeeding. Methods: This randomized controlled study was conducted in a tertiary hospital in Turkey with 100 term infants delivered by elective cesarean section with spinal anesthesia. The participants were randomly assigned to the early cord clamping (ECC) group or DCC group. The Infant Breastfeeding Assessment Tool (IBFAT) was used to assess infant alertness, breastfeeding behaviors, and maternal satisfaction with breastfeeding within the first 2 hours of life. Results: Scores on the IBFAT were significantly higher in the DCC group compared with the ECC group (p = 0.02). Maternal satisfaction with breastfeeding did not differ between the groups (p = 0.3). Infant alertness tended to be better in the DCC group, but the difference was not statistically significant (p = 0.08). Conclusion: The results of this study indicated that DCC was associated with more favorable breastfeeding behaviors compared with ECC.PMID:38738940 | DOI:10.1089/bfm.2024.0080… -
Persistent omphalomesenteric duct in an infant with trisomy 21
BMJ Case Rep. 2024 May 8;17(5):e259671. doi: 10.1136/bcr-2024-259671.ABSTRACTWe present the case of a term newborn with trisomy 21 who presented to the paediatric emergency department with periumbilical flare and green-brown discharge from a clamped umbilical cord, initially suspected to be omphalitis. However, it was noticed later, that when the infant strained or cried, a thick, bubbling and offensive green-brown discharge came out of the clamped umbilical cord with umbilical flatus. An ultrasound abdomen and umbilical cord confirmed the presence of a persistent omphalomesenteric duct (POMD). He was then transferred to the paediatric surgical unit. There, he underwent a laparotomy and surgical resection of the POMD and was discharged home 2 days later.PMID:38719262 | PMC:PMC11085785 | DOI:10.1136/bcr-2024-259671… -
OBSTRUCTED CONGENITAL HERNIA OF UMBILICAL CORD IN A NIGERIAN NEWBORN AND ITS DIAGNOSTIC CONUNDRUM
Ann Ib Postgrad Med. 2023 Dec;21(3):75-78. Epub 2024 Jan 30.ABSTRACTBACKGROUND: Congenital Hernia of umbilical cord (CHUC) is a rare presentation. The failure of return of intestinal loops following physiological herniation has been postulated as the embryological basis of this condition. This is usually mistakenly termed as omphalocele minor. We aim to highlight this rare finding, the clinical features, diagnostic dilemma, and management of CHUC.CASE PRESENTATION: He is a 4-day old male with obstructed CHUC. He had an oedematous umbilical stump, with circumferential normal abdominal wall skin folds in the form of a collar wrapping round the proximal aspect of the protrusion. The umbilical defect measured about 4 cm in diameter. Subsequently, surgical reduction and repair of defect was done, with resolution of symptoms.CONCLUSION: CHUC though a rare entity and easily missed, accurate diagnosis and management offer good prognosis. Also, recognition will prevent iatrogenic bowel injury from careless clamping of the cord with associated morbidity and mortality. It also helps to prevent mis categorization and prevent unwarranted anxiety with misdiagnosis.PMID:38706623 | PMC:PMC11065190… -
Quality improvement efforts directed at optimal umbilical cord management in delivery room
Semin Perinatol. 2024 Apr;48(3):151905. doi: 10.1016/j.semperi.2024.151905. Epub 2024 Apr 19.ABSTRACTDelayed or deferred cord clamping (DCC) and umbilical cord milking (UCM) benefit all infants by optimizing fetal-neonatal transition and placental transfusion. Even though DCC is recommended by almost all maternal and neonatal organizations, it has not been universally implemented. There is considerable variation in umbilical cord management practices across institutions. In this article, we provide examples of successful quality improvement (QI) initiatives to implement optimal cord management in the delivery room. We discuss a number of key elements that should be considering among those undertaking QI efforts to implement DCC and UCM including, multidisciplinary team collaboration, development of theory for change, mapping of the current and ideal process and workflow for cord management, and creation of a unit-specific evidence-based protocol for cord management. We also examine important strategies for implementation and provide suggestions for developing a system for measurement and benchmarking.PMID:38679508 | DOI:10.1016/j.semperi.2024.151905…
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