Mask Continuous Positive Airway Pressure Therapy with Simultaneous Extrauterine Placental Transfusion for Resuscitation of Preterm Infants - A Preliminary Study

Abstract

Background: Delayed cord clamping or cord milking improves cardiovascular stability and outcome of preterm infants. However, both techniques may delay initiation of respiratory support. To allow lung aeration during cord blood transfusion, we implemented an extrauterine placental transfusion (EPT) approach. This study aimed to provide a detailed description of the EPT procedure and to evaluate its impact on the outcome of infants.

Methods: A retrospective analysis was performed comprising 60 preterm infants (220/7 to 316/7 weeks of gestation). Of these, 40 were transferred to the resuscitation unit with the placenta still connected to the infant. In this EPT group, continuous positive airway pressure support was initiated while, simultaneously, placental blood was transfused by holding the placenta 40-50 cm above the infant's heart. The cords of another 20 infants were clamped before respiratory support was started (standard group). Data on the infants' outcome were compared retrospectively. In a subgroup of 22 infants (n = 14 EPT, n = 8 standard), respiratory function monitor recordings were performed and both heart rates and SpO2 levels in the first 10 min of life were compared between groups.

Results: Although infants in the EPT group were lighter (EPT: 875 ± 355 g, standard: 1,117 ± 389 g; p = 0.02) and younger (266/7 weeks ± 19 days vs. 282/7 weeks ± 18 days; p = 0.045), there was no difference in neonatal outcome, including the incidence of intraventricular hemorrhage, bronchopulmonary disease, and red blood cell transfusions (all p > 0.1). Moreover, no differences in SpO2 levels and heart rates were observed in the infants whose resuscitations were recorded using a respiratory function monitor.

Conclusions: In this retrospective analysis, EPT had no negative effects on the outcome of the infants, which warrants further evaluation in prospective randomized studies.

Keywords: Cord milking; Delayed cord clamping; Fetal-to-neonatal transition; Lung aeration; Very-low-birth-weight infants.

Copyright © 2018 by S. Karger AG, Basel.

Figures

Fig. 1

Schematic overview of the patient population of the study.

Fig. 2

a Picture of the EPT procedure with simultaneous mask CPAP support. b Image of the umbilical cord at the beginning of the EPT procedure (a) and after 5 min of the manoeuver (b). Note the collapsed cord after aeration of the lungs.

Fig. 3

a Oxygen saturations during the first minutes of life. Box plots represent the median, IQR, maximum and minimum values. Values more than 1.5 IQRs from the end of the box are labelled as outliers (⚫); values more than 3 IQRs from the box are labelled as extremes (*). b Heart rate during the first minutes of life. Box plots represent the median, IQR, maximum and minimum values. Values more than 1.5 IQRs from the end of the box are labelled as outliers (⚫), values more than 3 IQRs from the box are labelled as extremes (*).