Benefits of Delayed Cord Clamping in Red Blood Cell Alloimmunization

Garabédian, Charles; Rakza, Thameur; Drumez, Élodie; Poleszczuk, Marion; Ghesquière, Louise; Wibaut, B.; Depoortere, Marie-Hélène; Vaast, P.; Storme, Laurent; Houfflin‐Debarge, V.

doi:10.1542/peds.2015-3236

Cited by 50 publications

(34 citation statements)

References 36 publications

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“…Several studies support the benefits of DCC and demonstrate the absence of association with increased risk of hyperbilirubinemia or symptomatic polycythaemia. Consistently with literature data, mean birthweight in DCC group is significantly higher than ECC group [27,28]. DCC 2 minutes after birth is particularly beneficial in newborns from HIV mothers due to high prevalence of anaemia in this population.…”

Section: Discussionsupporting

confidence: 90%

Effects and safety of delayed versus early umbilical cord clamping in newborns of HIV-infected mothers

Pogliani

Erba

Nannini

et al. 2017

The Journal of Maternal-Fetal & Neonatal Medicine

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Objective: To investigate the effect of a 2 minutes-delayed cord clamp (DCC) versus early cord clamp (ECC) on neonate haemoglobin concentration 24 hours and 1 month after birth, and assess the safety of DCC concerning the risk of HIV infection. Design: Sixty-four mother-infant peers were enrolled. All mothers were on stable ARV therapy. Viral load, CD4 þ count and blood haemoglobin (Hb) concentrations 24 hours before delivery were collected from all mothers and their infants. Methods: All patients were enrolled at the Department of Paediatrics, AO FBF Sacco Hospital in Milan, and were followed until 18 months after birth. Women with haematological diseases and obstetrical complications were excluded. All of 64 mother and infants couples (32 ECC group and 32 DCC group) completed the study. ECC and DCC are defined as application of umbilical clamp within 30 seconds and 120 seconds after birth, respectively. Results: Mean birth weight was significantly higher in the DCC compared with ECC group. Mean Hb levels at birth were significantly higher in DCC than in ECC group (p ¼ .05): this difference persisted at 1 month of life. All newborns showed negative viral load. Conclusions: DCC 2 minutes after birth is proven to be a safe procedure, particularly beneficial in newborns from HIV mothers. The risk of anemia is significantly decreased at 24 hours after birth and persists at age of 1 month without any increased risk of neonatal jaundice or polycitemia. ARTICLE HISTORY

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Section: Discussionsupporting

confidence: 90%

Effects and safety of delayed versus early umbilical cord clamping in newborns of HIV-infected mothers

Pogliani

Erba

Nannini

et al. 2017

The Journal of Maternal-Fetal & Neonatal Medicine

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“…In a term newborn, this transfusion can consist up to one-quarter to one-third of the total neonatal blood volume [65]. In anemia secondary to erythrocyte alloimmunization, a significant increase in hemoglobulin levels at birth was observed, as well as a longer delay between birth and first transfusion, and a decrease in the number of postnatal exchange transfusions, with no notable adverse effects [66,67].…”

Section: Delayed Cord Clampingmentioning

confidence: 99%

Neonatal management and outcome in alloimmune hemolytic disease

Ree

Smits-Wintjens

Bom

et al. 2017

Expert Review of Hematology

103

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Introduction: Hemolytic disease of the fetus and newborn (HDFN) occurs when fetal and neonatal erythroid cells are destroyed by maternal erythrocyte alloantibodies, it leads to anemia and hydrops in the fetus, and hyperbilirubinemia and kernicterus in the newborn. Postnatal care consists of intensive phototherapy and exchange transfusions to treat severe hyperbilirubinemia and top-up transfusions to treat early and late anemia. Other postnatal complications have been reported such as thrombocytopenia, iron overload and cholestasis requiring specific management. Areas covered: This review focusses on the current neonatal management and outcome of hemolytic disease and discusses postnatal treatment options as well as literature on long-term neurodevelopmental outcome. Expert commentary: Despite major advances in neonatal management, multiple issues have to be addressed to optimize postnatal management and completely eradicate kernicterus. Except for strict adherence to guidelines, improvement could be achieved by clarifying the epidemiology and pathophysiology of HDFN. Several pharmacotherapeutic agents should be further researched as alternative treatment options in hyperbilirubinemia, including immunoglobulins, albumin, phenobarbital, metalloporphyrins, zinc, clofibrate and prebiotics. Larger trials are warranted to evaluate EPO, folate and vitamin E in neonates. Long-term follow-up studies are needed in HDFN, especially on thrombocytopenia, iron overload and cholestasis.ARTICLE HISTORY

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“…Rhesus disease is responsible for about 114,000 neonatal deaths and 76,000 cases of kernicterus per year worldwide (5), especially in low-income countries where antenatal anti-D prophylaxis is not guaranteed. Rhesus disease was excluded in most DCC trials, as it was likely that DCC increased the risk for hyperbilirubinemia due to the higher amount of opsonized Red Blood Cells (RBC) transfused from the placenta to the newborn that could undergo hemolysis.…”

Section: Introductionmentioning

confidence: 99%

Delayed Cord Clamping Increased the Need for Phototherapy Treatment in Infants With AB0 Alloimmunization Born by Cesarean Section: A Retrospective Study

et al. 2018

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Objective: To compare the effect of Delayed Cord Clamping (DCC) to Immediate Cord Clamping (ICC) on phototherapy treatment in a cohort of cesarean-delivered newborns with AB0-alloimmunization.Study Design: In a retrospective cohort study neonates with Gestational Age (GA) ≥ 35 weeks and diagnosed with AB0-alloimmunization before implementation of DCC (ICC group) were compared with neonates born after implementation (DCC group). The primary outcome was the need for phototherapy. Secondary outcomes included hospital stay, readmission rate, need for extra intravenous fluids, maximum bilirubin concentration, and hours of life at bilirubin peak. We used regression models to adjust for weight loss, type of feeding, birth weight, and gestational age.Results: In total 336 neonates were included, of which 192 neonates in the ICC group and 144 in the DCC group. There were no differences in basic characteristics between the two groups except for birth weight (ICC 3193 ± 468 g vs. DCC 3053 ± 446 g, p = 0.01) and GA (ICC 38.2 ± 1 weeks of GA, vs. DCC 37.9 ± 1 weeks of GA; p = 0.01). When adjusted for confounding factors, after implementation of DCC, significantly more infants with AB0 alloimmunization needed phototherapy (22.4% vs. 36.8%, RR 1.61 CI: 1.15–2.28; p = 0.006; Number Needed to Harm 7), needed to stay longer in hospital (20.3% vs. 30.5%, RR 1.53 CI: 1.05–2.23; p = 0.03). The maximum bilirubin was higher (11.4 ± 4.0 mg/dl vs. 12.9 ± 3.5 mg/dl, p < 0.001) and occurred later [74 (67–92) hours vs. 84 (70–103) hours; p = 0.04]. There was no difference in the need for intravenous fluids (1.6% vs. 4.9%; not significant) and readmissions (1.6% vs. 3.5%; not significant).Conclusion: Infants with AB0 alloimmunization needed more often phototherapy and were admitted longer after implementation of DCC policy. Further studies are needed to see whether the benefit of DCC outweighs the increased morbidity, admission days, and related hospital costs.

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Benefits of Delayed Cord Clamping in Red Blood Cell Alloimmunization

Abstract: BACKGROUND AND OBJECTIVE: Several studies have shown the benefits of delayed cord clamping (DCC) in preterm and in healthy newborns at short and long term. Our objective was to evaluate the potentials benefits and risks of DCC in red cell alloimmunization.

Cited by 50 publications

References 36 publications

Effects and safety of delayed versus early umbilical cord clamping in newborns of HIV-infected mothers

Effects and safety of delayed versus early umbilical cord clamping in newborns of HIV-infected mothers

Neonatal management and outcome in alloimmune hemolytic disease

Delayed Cord Clamping Increased the Need for Phototherapy Treatment in Infants With AB0 Alloimmunization Born by Cesarean Section: A Retrospective Study

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