Neonatal Resuscitation with an Intact Cord: A Randomized Clinical Trial

Abstract

Objective: To assess whether providing ventilation during delayed cord clamping (V-DCC) increases placental transfusion compared with delayed cord clamping alone (DCC only).

Study design: Inborn premature infants (230/7-316/7 weeks' gestational age) were randomized to receive at least 60 seconds of V-DCC (initial continuous positive airway pressure) with addition of positive pressure ventilation if needed) or without assisted ventilation (DCC only). For the DCC-only group, infants were dried and stimulated by gently rubbing the back if apneic. The primary outcome was the peak hematocrit in the first 24 hours of life. Delivery room outcomes were analyzed from video recordings and a data acquisition system. Hemodynamic measurements were performed with the use of functional echocardiography, near-infrared spectroscopy, and electrical cardiometry.

Results: There was no difference in the primary outcome of peak hematocrit in the first 24 hours of life. The onset of breathing was similar between both groups (25 ± 20 and 27 ± 28 seconds, P = .627); however, infants receiving DCC received a greater duration of stimulation than V-DCC (41 ± 19 and 20 ± 21 seconds P = .002). There were no differences in delivery room interventions, early hemodynamics (cerebral oxygenation by near-infrared spectroscopy, cardiac output and stroke volume by electrical cardiometry, or superior vena cava flow by of functional echocardiography), or neonatal outcomes.

Conclusions: V-DCC was feasible but did not lead to any measurable clinical improvements immediately after delivery or reduce subsequent neonatal morbidity. Caretakers should consider providing adequate stimulation before cord clamping.

Trial registration: ClinicalTrials.gov: NCT02231411.

Keywords: cesarean delivery; delayed cord clamping; intraventricular hemorrhage; resuscitation.

Conflict of interest statement

The authors declare no conflicts of interest.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Figure 1

(online) CONSORT Diagram.

Figure 2

(online) Heart rate (HR), peripheral arterial oxygen saturation (SpO2), administered inspired fractional oxygen (FiO2), Mean Airway pressure (Map) over the first 10 minutes of resuscitation (600 seconds). BPM – beats per minute, VDCC – ventilation during delayed cord clamping, DCC – delayed cord clamping only. *p

Figure 3

(online) Blood pressure (BP), cerebral oxygenation (StO2), arterial oxygenation (SpO2), fractional oxygen extraction (FTOE), respiratory rate (RR), heart rate (HR), cardiac output (CO) and stroke volume (SV) changes over the first 24 hours of life in neonates receiving DCC or VDCC. Dia- diastolic, Mn- Mean, Sys- Systolic, bpm- beats per minute, VDCC-ventilation during delayed cord clamping, DCC- delayed cord clamping alone. *p