Better timing for cord clamping is after onset of lung aeration

Lakshminrusimha, Satyanarayana; Meurs, Krisa P. Van

doi:10.1038/pr.2015.23

Cited by 13 publications

(9 citation statements)

References 23 publications

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“…First, Katheria et al [41] they stated that increasing fetal hemoglobin by placental transfusion through DCC is an extremely effective method of increasing arterial oxygen content, and improving oxygen delivery. Second, Lakshminrusimha and Neurs [42] who had conducted a study entitled "better timing for cord clamping is after onset of lung aeration". They stated that DCC conserves oxygenation by sustained placental circulation and is valuable if spontaneous respiration is delayed or compromised.…”

Section: Discussionmentioning

confidence: 99%

Effects of Deferred Versus Early Umbilical Cord Clamping on Maternal and Neonatal Outcomes

Elgzar¹,

Ibrahim²,

Elkhateeb³

2017

AJNR

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Background: Recent protocol proposed by the World Health Organization to manage the third stage of labour replaced the early cord clamping by deferred cord clamping to induce numerous neonatal benefits. But this practice is still resisted in most of the Arab countries. The aim of this study was to evaluate the effectiveness of deferred versus early umbilical cord clamping on maternal and neonatal outcomes. Methods: A quasi experimental research design was utilized. The study was conducted at labour unit in Damanhour National Medical Institute. Sample: A convenience sample of 150 parturient women undergoing normal vaginal delivery were randomly divided in two groups; deferred cord clamping (n= 75) and early cord clamping (n= 75). Tools: Three tools were used for data collection; 1) Structured interview schedule to collect data about the women' demographic characteristics and reproductive history. 2) Maternal outcomes assessment sheet. 3) Neonatal outcomes assessment sheet to assess the immediate and late neonatal outcomes. Results: There were no statistically significant differences (P > 0.05) between deferred and early cord clamping groups in relation to the maternal risk for post-partum hemorrhage, duration of third stage of labour and the need for manual removal of the placenta. Furthermore, a highly statistically significant differences (p < 0.001) were observed regarding neonatal hemoglobin, hematocrit, and red blood cells between the two groups. The mean total bilirubin level was significantly higher (P < 0.05) in the deferred cord clamping group than early cord clamping group. Conclusion: The study concluded that deferred umbilical cord clamping did not increase the risk of maternal post-partum hemorrhage, duration of third stage of labour or the need for manual removal of the placenta. Also, deferred cord clamping significantly increased neonatal hemoglobin, hematocrit, and red blood cells level without serious elevation in the total bilirubin level as it was still in the low intermediate risk or below 75 th percentile. Recommendation: Institutionalization of deferred cord clamping in all governmental hospitals and medical educational settings through providing policies, procedures and guidelines regarding this practice. This could significantly improve the intra-natal care for the neonate without harmful consequences for the mother.

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Section: Discussionmentioning

confidence: 99%

Effects of Deferred Versus Early Umbilical Cord Clamping on Maternal and Neonatal Outcomes

Elgzar¹,

Ibrahim²,

Elkhateeb³

2017

AJNR

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“…DCC improves blood pressure, reduces the need for blood transfusions and the risk of intra-ventricular haemorrhage and necrotizing enterocolitis in preterm infants [9]. Furthermore, DCC maintains oxygenation by sustained placental circulation and is beneficial if spontaneous pulmonary respiration is delayed or impaired [10][11][12][13]. Recently the use of the term 'deferred' cord clamping has been recommended as this suggests a planned policy in contrast to the term 'delayed' cord clamping which may imply that the cord is clamped later than the ideal time [14].…”

Section: Introductionmentioning

confidence: 99%

Effects of early versus delayed umbilical cord clamping during antepartum lower segment caesarean section on placental delivery and postoperative haemorrhage: a randomised controlled trial

Withanathantrige¹,

Goonewardene²

2017

Ceylon Med. J.

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Effects of early versus delayed umbilical cord clamping during antepartum lower segment caesarean section on placental delivery and postoperative haemorrhage: a randomised controlled trial M Withanathantrige 1 , I M R Goonewardene 1 IntroductionDelayed cord clamping (DCC), an inexpensive method which allows physiological placental transfusion has been described since the 1950s [1,2]. DCC is associated with increased birth weight, (mean difference 101g; 95% CI 45-157), increased new born haemoglobin (mean difference 2.2 g/dl; 95% CI 0.3-4.0 g/dl), increased new born haematocrit >45% (RR 16.2; 95% CI 2-127.4) persisting up to 48 hours, and a reduction of the risk of iron deficiency at three to six months of age (RR 2.7; 95% CI 1.0-6.7) [3]. The requirement of phototherapy for neonatal jaundice is reduced by early cord clamping (RR 0. 62; 95% CI 0.41-0.96) compared to DCC [3]. However DCC is not associated with lower Apgar Scores at 5 minutes, increased admission to special care baby units, respiratory distress, severe jaundice or long term adverse effects [3][4][5][6][7]. DCC is also not associated with increased risk of postpartum haemorrhage, blood transfusion, manual removal of placenta or increased duration of third stage of labour [3,[6][7][8]. DCC improves blood pressure, reduces the need for blood transfusions and the risk of intra-ventricular haemorrhage and necrotizing enterocolitis in preterm infants [9]. Furthermore, DCC maintains oxygenation by sustained placental circulation and is beneficial if spontaneous pulmonary respiration is delayed or impaired [10][11][12][13]. Recently the use of the term 'deferred' cord clamping has been recommended as this suggests a planned policy in contrast to the term 'delayed' cord clamping which may imply that the cord is clamped later than the ideal time [14].Although evidence based guidelines have recommended that DCC should be practiced for all births, in

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“…Recent evidence suggests that initiation of resuscitation and ventilation of the lungs before clamping the cord results in stable cerebral blood flow and influence SpO 2 and oxygen delivery to the brain (28,29). Further studies to evaluate the impact of delayed cord clamping and ventilation before cord clamping on SpO 2 during resuscitation are warranted.…”

Section: Discussionmentioning

confidence: 99%

Neonatal resuscitation adhering to oxygen saturation guidelines in asphyxiated lambs with meconium aspiration

et al. 2015

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BACKGROUND The Neonatal Resuscitation Program (NRP) recommends upper and lower limits of preductal saturations (SpO2) extrapolated from studies in infants resuscitated in room air. These limits have not been validated in asphyxia and lung disease. METHODS Seven control term lambs delivered by cesarean section were ventilated with 21% O2. Thirty lambs with asphyxia with meconium aspiration were randomly assigned to resuscitation with 21% O2 (n = 6), 100% O2 (n = 6), or initiation with 21% O2 followed by variable FIO2 to maintain NRP target SpO2 ranges (n = 18). Hemodynamic and ventilation parameters were recorded for 15 min. RESULTS Control lambs maintained preductal SpO2 near the lower limit of NRP target range. Asphyxiated lambs had low SpO2 (38 ± 2%), low arterial pH (6.99 ± 0.01), and high PaCO2 (96 ± 7 mm Hg) at birth. Resuscitation with 21% O2 resulted in SpO2 values below the target range with low pulmonary blood flow (Qp) compared to variable FIO2 group. The increase in PaO2 and Qp with variable FIO2 resuscitation was similar to control lambs. CONCLUSION Maintaining SpO2 as recommended by NRP by actively adjusting inspired O2 leads to effective oxygenation and higher Qp in asphyxiated lambs with lung disease. Our findings support the current NRP SpO2 guidelines for O2 supplementation during resuscitation of an asphyxiated neonate.

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Better timing for cord clamping is after onset of lung aeration

Cited by 13 publications

References 23 publications

Effects of Deferred Versus Early Umbilical Cord Clamping on Maternal and Neonatal Outcomes

Effects of Deferred Versus Early Umbilical Cord Clamping on Maternal and Neonatal Outcomes

Effects of early versus delayed umbilical cord clamping during antepartum lower segment caesarean section on placental delivery and postoperative haemorrhage: a randomised controlled trial

Neonatal resuscitation adhering to oxygen saturation guidelines in asphyxiated lambs with meconium aspiration

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