Umbilical cord milking improves transition in premature infants at birth

Anup Katheria, Doug Blank, Wade Rich, Neil Finer, Anup Katheria, Doug Blank, Wade Rich, Neil Finer

Abstract

Background: Umbilical cord milking (UCM) improves blood pressure and urine output, and decreases the need for transfusions in comparison to immediate cord clamping (ICC). The immediate effect of UCM in the first few minutes of life and the impact on neonatal resuscitation has not been described.

Methods: Women admitted to a tertiary care center and delivering before 32 weeks gestation were randomized to receive UCM or ICC. A blinded analysis of physiologic data collected on the newborns in the delivery room was performed using a data acquisition system. Heart rate (HR), SpO2, mean airway pressure (MAP), and FiO2 in the delivery room were compared between infants receiving UCM and infants with ICC.

Results: 41 of 60 neonates who were enrolled and randomized had data from analog tracings at birth. 20 of these infants received UCM and 21 had ICC. Infants receiving UCM had higher heart rates and higher SpO2 over the first 5 minutes of life, were exposed to less FiO2 over the first 10 minutes of life than infants with ICC.

Conclusions: UCM when compared to ICC had decreased need for support immediately following delivery, and in situations where resuscitation interventions were needed immediately, UCM has the advantage of being completed in a very short time to improve stability following delivery.

Trial registration: ClinicalTrials.gov NCT01434732.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Consort Diagram.
Figure 1. Consort Diagram.
Figure 2. Changes in Heart Rate over…
Figure 2. Changes in Heart Rate over time in infants receiving umbilical cord milking (UCM) compared to immediate cord clamping (ICC).
The babies receiving UCM had significantly higher heart rates over the first 5 minutes of resuscitation (ANOVA P = 0.032). *P<0.05 compared to ICC.
Figure 3. Changes in Oxygen Saturation (SpO…
Figure 3. Changes in Oxygen Saturation (SpO2) over time in infants receiving umbilical cord milking (UCM) compared to immediate cord clamping (ICC).
The babies receiving UCM had significantly higher SpO2 over the first 5 minutes of resuscitation (ANOVA P = 0.015). *P<0.05 compared to ICC.
Figure 4. Changes in Inspired Fractional oxygen…
Figure 4. Changes in Inspired Fractional oxygen concentration (FiO2) over time in infants receiving umbilical cord milking (UCM) compared to im mediate cord clamping (ICC).
The babies receiving UCM received significantly less supplemental FiO2 over the first 10 minutes of resuscitation (ANOVA, P = 0.04). *P<0.05 compared to ICC.
Figure 5. Changes in mean airway pressure…
Figure 5. Changes in mean airway pressure (MAP) over time in infants receiving umbilical cord milking (UCM) compared to immediate cord clamping (ICC).
During the first five minutes of resuscitation, there was a non-significant trend towards a lower mean airway pressure requirement in infants in the UCM (ANOVA, P = 0.13).

References

    1. Committee on Obstetric Practice ACoO, Gynecologists (2012) Committee Opinion No. 543: Timing of umbilical cord clamping after birth. Obstet Gynecol 120: 1522–1526.
    1. Kattwinkel J, Perlman JM, Aziz K, Colby C, Fairchild K, et al. (2010) Neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 126: e1400–1413.
    1. Brady JP, James LS (1962) Heart rate changes in the fetus and newborn infant during labor, delivery, and the immediate neonatal period. Am J Obstet Gynecol 84: 1–12.
    1. Dawson JA, Kamlin CO, Wong C, te Pas AB, Vento M, et al. (2010) Changes in heart rate in the first minutes after birth. Arch Dis Child Fetal Neonatal Ed 95: F177–181.
    1. Bhatt S, Alison BJ, Wallace EM, Crossley KJ, Gill AW, et al. (2013) Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs. J Physiol 591: 2113–2126.
    1. Hosono S, Mugishima H, Fujita H, Hosono A, Minato M, et al. (2008) Umbilical cord milking reduces the need for red cell transfusions and improves neonatal adaptation in infants born at less than 29 weeks' gestation: a randomised controlled trial. Arch Dis Child Fetal Neonatal Ed 93: F14–19.
    1. March MI, Hacker MR, Parson AW, Modest AM, de Veciana M (2013) The effects of umbilical cord milking in extremely preterm infants: a randomized controlled trial. J Perinatol.
    1. Katheria A, Rich W, Finer N (2012) Electrocardiogram provides a continuous heart rate faster than oximetry during neonatal resuscitation. Pediatrics 130: e1177–1181.
    1. Gandhi B, Rich W, Finer N (2013) Time to achieve stable pulse oximetry values in VLBW infants in the delivery room. Resuscitation 84: 970–973.
    1. Dawson JA, Kamlin CO, Vento M, Wong C, Cole TJ, et al. (2010) Defining the reference range for oxygen saturation for infants after birth. Pediatrics 125: e1340–1347.
    1. Gandhi B, Rich W, Finer N (2013) Achieving targeted pulse oximetry values in preterm infants in the delivery room. J Pediatr 163: 412–415.
    1. Katheria AC, Leone TA, Woelkers D, Garey DM, Rich W, et al... The Effects of Umbilical Cord Milking on Hemodynamics and Neonatal Outcomes in Premature Neonates. The Journal of Pediatrics.
    1. Rabe H, Diaz-Rossello JL, Duley L, Dowswell T (2012) Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 8: CD003248.
    1. Kaempf JW, Tomlinson MW, Kaempf AJ, Wu Y, Wang L, et al. (2012) Delayed umbilical cord clamping in premature neonates. Obstet Gynecol 120: 325–330.
    1. Rich WD, Auten KJ, Gantz MG, Hale EC, Hensman AM, et al. (2010) Antenatal consent in the SUPPORT trial: challenges, costs, and representative enrollment. Pediatrics 126: e215–221.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅