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- Afif El-Khuffash (Ireland)
- Heike Rabe (United Kingdom)
UPDATE ON CORD CLAMPING
- Eugene M. Dempsey (Ireland)
Abstract
Abstract Body
Our understanding of the physiology of neonatal adaptation and the associated importance of cord management strategies has increased substantially over the last 10 years, much of this as a results of excellent animla studies. As the clincial evidence increases supporting various cord management strategies, many international organisations have now endorsed delayed cord clamping as the primary cord management strategy for the term and preterm infant. However, many questions remain to be answered in this important aspect of care. In this presentation we will review some of the key animal work in this area, and review the clinical evidence supporting various practices including delayed cord clamping, umbilical cord milking, physiological based cord management, and delayed cord clamping with resuscitation in the preterm infant. We will explore both short term physiological benefits, and longer term health benefits of the various strategies employed. We will also explore which technique may be best for the non vigorous term newborn.
CORD CLAMPING TIME AND JAUNDICE REQUIRING PHOTOTHERAPY – TIME TO RECONSIDER THE RISK?
- Jenny Svedenkrans (Sweden)
Abstract
Background and Aims
Delaying cord clamping for 2-3 minutes in vigorous term infants is well known to provide better iron stores, higher hematocrit levels and improved neurodevelopment. However, in systematic reviews, an elevated risk of jaundice requiring phototherapy is commonly declared as a possible complication. The aim of this study was to analyze the correlation between cord clamping time and bilirubin levels as well as need for phototherapy in a large group of vaginally born infants.
Methods
Pooled data from four studies on cord clamping. Data on cord clamping time and phototherapy treatment were collected prospectively. Bilirubin was measured either in serum or transcutaneously in conjunction with the metabolic screen.
Results
Data from 1821 infants (50.4% boys) were analyzed. Mean (SD) gestational age and birth weight were 40.0 (1.2) weeks and 3582 (467) g respectively. Cord clamping was performed at a median (IQR) time of 313 (180-435) sec. A total of 28 (1.5%) infants were treated with phototherapy. There was no correlation between cord clamping time and bilirubin level (B=0.000, p=0.989). Median (IQR) cord clamping time was 300 (180-478) sec in infants treated with phototherapy and 316 (180-435) sec in infants not treated with phototherapy (p=0.962). Cord clamping time had no correlation to need for phototherapy, (OR 1.00, 95% CI: 0.998-1.002, p=0.851).
Conclusions
No correlation between cord clamping time and bilirubin levels or requirement of phototherapy was found in this large cohort of 1821 vaginally delivered infants. The authors suggest that delayed cord clamping can be practiced without extra concerns regarding jaundice.
FEASIBILITY AND IMPACT OF PHYSIOLOGICAL BASED CORD CLAMPING (PBCC) ON VERY LOW BIRTH WEIGHT INFANTS DURING THE FIRST 72 HOURS AFTER BIRTH
- Nina Höller (Austria)
Abstract
Background and Aims
The present observational study investigated the feasibility of physiological based cord clamping (PBCC) and its impact on very low birth weight [VLBW] infants during the first 72 hours after birth.
Methods
VLBW infants (<32 weeks gestational age [GA]) with a birth weight [BW] <1500g were included. Neonates delivered with PBCC were matched according to GA (± 1 week) and BW (± 100g) to neonates with routine care (control-group) and a cord clamping time of 30-60sec. Neonates of the PBCC-group were stabilised after birth with an intact cord using a mobile and heated resuscitation table (Concord birth trolley, Rotterdam, Netherlands). Routine monitoring parameters (heart rate [HR], arterial oxygen saturation [SpO2], fraction of inspired oxygen [FiO2], mean arterial blood pressure [MABP]) were recorded and compared between the two groups.
Results
54 VLBW infants (PBCC n=27; control n=27) were included. Mean GA of the PBCC-group was 27.4±1.9 weeks and 27.4±1.8 weeks in the control-group (p-value 0.869), mean BW was 912±288 g and 915±285 g (p-value 0.964), respectively. Cord clamping time was 191±78 sec in the PBCC-group. HR was lower in the PBCC-group during the first three days after birth, reaching significance during 11 hours. All other monitoring parameters did not reveal any significant differences between the two groups.
Conclusions
PBCC is feasible and has no negative influence on cardiorespiratory stability in VLBW infants during the first 72 hours after birth, compared to routine delayed cord clamping. The lower HR in the PBCC-group suggests higher blood volume due to intact cord resuscitation.