Blood Pressure and Cerebral Oxygenation with Physiologically-based Cord Clamping: A Sub-Study of the BabyDUCC Trial

Abstract

Background Cord-clamping strategies may modify blood pressure (BP) and cerebral tissue oxygen saturation (rStO2) immediately after birth. Methods We conducted a sub-study nested within the Baby-Directed Umbilical Cord-Clamping trial. Infants ≥32+0 weeks gestation assessed as requiring resuscitation were randomly allocated to either physiologically-based cord clamping (PBCC), where resuscitation commenced prior to umbilical cord clamping, or standard care where cord clamping occurred early (ECC). In this single-site sub-study, we obtained additional measurements of pre-ductal BP and rStO2. In a separate observational arm, non-randomised vigorous infants received 2 minutes of deferred cord clamping (DCC) and contributed data for reference percentiles. Results Among 161 included infants, n=55 were randomly allocated to PBCC (n= 30) or ECC (n= 25). The mean (SD) BP at 3-4 minutes after birth (primary outcome) in the PBCC group was 64 (10) mmHg compared to 62 (10) mmHg in the ECC group, mean difference 2 mmHg (95% confidence interval -3 to 8 mmHg, p= 0.42). BP and rStO2 were similar across both randomised arms and the observational arm (n=106). Conclusion We found no difference in BP or rStO2 with the different cord clamping strategies. We report reference ranges for BP and rStO2 for late-preterm and full-term infants receiving DCC.