Clamping the Umbilical Cord in Premature Deliveries (CUPiD): Neuromonitoring in the Immediate Newborn Period in a Randomized, Controlled Trial of Preterm Infants Born at &lt;32 Weeks of Gestation

Finn, Daragh; Ryan, David L.; Pavel, Andreea; O’Toole, John M.; Livingstone, Vicki; Boylan, Geraldine B.; Kenny, Louise C.; Dempsey, Eugene M.

doi:10.1016/j.jpeds.2018.12.039

Cited by 28 publications

(23 citation statements)

References 28 publications

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“…Timing of umbilical cord clamping has an impact on neonatal hemodynamics and may affect both body temperature and cerebral tissue oxygenation. Whereas studies reported no differences in cerebral tissue oxygenation six to 12 h after birth when comparing immediate and delayed cord clamping [26], Pichler et al demonstrated that delayed cord clamping caused lower initial cerebral tissue oxygen saturation in spontaneously breathing preterm neonates compared to preterm neonates without immediate cord clamping [27,28]. Furthermore, we observed a high rate of normothermic infants and, therefore, temperature differences may have been more pronounced in other studies.…”

Section: Discussioncontrasting

confidence: 53%

Association between Regional Tissue Oxygenation and Body Temperature in Term and Preterm Infants Born by Caesarean Section

et al. 2020

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Body temperature (BT) management remains a challenge in neonatal intensive care, especially during resuscitation after birth. Our aim is to analyze whether there is an association between the BT and cerebral and peripheral tissue oxygen saturation (crSO2/cTOI and prSO2), arterial oxygen saturation (SpO2), and heart rate (HR). The secondary outcome parameters of five prospective observational studies are analyzed. We include preterm and term neonates born by Caesarean section who received continuous pulse oximetry and near-infrared spectroscopy monitoring during the first 15 min, and a rectal BT measurement once in minute 15 after birth. Four-hundred seventeen term and 169 preterm neonates are included. The BT did not correlate with crSO2/cTOI and SpO2. The BT correlated with the HR in all neonates (ρ = 0.210, p < 0.001) and with prSO2 only in preterm neonates (ρ = −0.285, p = 0.020). The BT was lower in preterm compared to term infants (36.7 [36.4–37.0] vs. 36.8 [36.6–37.0], p = 0.001) and prevalence of hypothermia was higher in preterm neonates (29.5% vs. 12.0%, p < 0.001). To conclude, the BT did not correlate with SpO2 and crSO2/cTOI, however, there was a weak positive correlation between the BT and the HR in the whole cohort and a weak correlation between the BT and prSO2 only in preterm infants. Preterm neonates had a statistically lower BT and suffered significantly more often from hypothermia during postnatal transition.

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Section: Discussioncontrasting

confidence: 53%

Association between Regional Tissue Oxygenation and Body Temperature in Term and Preterm Infants Born by Caesarean Section

et al. 2020

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“…Nineteen RCTs [5 RCTs (n=922) comparing UCM with DCC,8 15–18 14 RCTs (n=1092) comparing UCM with ICC19–32] were included in this systematic review. Milking was performed on an intact cord (I-UCM) in 16 RCTs, while cut UCM was performed in 3 studies 20 26 30.…”

Section: Resultsmentioning

confidence: 99%

“…Meta-analysis estimated a significant increase in the risk of severe IVH in the UCM group when compared with DCC (RR 1.95 (95% CI 1.01 to 3.76), p=0.05, I 2 =0%, 4 studies8 15–17 (n=718)) (figure 2). Number needed to treat with UCM that could result in IVH >grade 3 in one additional infant (NNTH) was 29 (95% CI 500 to 15).…”

Section: Resultsmentioning

confidence: 99%

“…The authors found no significant benefits or harms from UCM; however, the overall quality of evidence was graded low to very low 34. In our systematic review, 10 additional studies8 15 18 20 21 27 28 30–32 have been included besides those summarised in the Cochrane review. While the Cochrane review included few studies that allowed cord milking as a cointervention in the DCC group,35 36 we excluded those studies in order to determine the standalone effects of UCM in preterm neonates.…”

Section: Discussionmentioning

confidence: 99%

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Umbilical cord milking in preterm infants: a systematic review and meta-analysis

Balasubramanian

Ananthan

Jain

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo conduct a systematic review and meta-analysis of the efficacy and safety of umbilical cord milking in preterm infants.DesignRandomised controlled trials comparing umbilical cord milking with delayed cord clamping/immediate cord clamping in preterm infants were identified by searching databases, clinical trial registries and reference list of relevant studies in November 2019. Fixed effects model was used to pool the data on various clinically relevant outcomes.Main outcome measuresMortality and morbidities in preterm neonates.ResultsNineteen studies (2014 preterm infants) were included. Five studies (n=922) compared cord milking with delayed cord clamping, whereas 14 studies (n=1092) compared milking with immediate cord clamping. Cord milking, as opposed to delayed cord clamping, significantly increased the risk of intraventricular haemorrhage (grade III or more) (risk ratio (RR): 1.95 (95% CI 1.01 to 3.76), p=0.05). When compared with immediate cord clamping, cord milking reduced the need for packed RBC transfusions (RR:0.56 (95% CI 0.43 to 0.73), p<0.001). There was limited information on long-term neurodevelopmental outcomes. The grade of evidence was moderate or low for the various outcomes analysed.ConclusionUmbilical cord milking, when compared with delayed cord clamping, significantly increased the risk of severe intraventricular haemorrhage in preterm infants, especially at lower gestational ages. Cord milking, when compared with immediate cord clamping, reduced the need for packed RBC transfusions but did not improve clinical outcomes. Hence, cord milking cannot be considered as placental transfusion strategy in preterm infants based on the currently available evidence.

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“…After birth, cord clamping is a necessary intervention, but the timing is important. Delayed cord clamping, for ≥1 min after birth, is essential to ensure sufficient transfer of placental blood to the baby, increasing its blood volume and stabilizing the cardiorespiratory system, in turn minimizing need for transfusions (Ersdal et al, 2016;Ersdal, Linde, Mduma, Auestad, & Perlman, 2014;Finn et al, 2019;McAdams, Backes, Fathi, & Hutchon, 2018). In the preterm infant, adult haemoglobin will be at a lower concentration than in term infants, with preterm infants still circulating fetal haemoglobin.…”

Section: F I G U R Ementioning

confidence: 99%

The impact of preterm adversity on cardiorespiratory function

McDonald

Dempsey

O’Halloran

2019

Experimental Physiology

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Preterm birth is one of the leading causes of neonatal mortality. Babies that survive early-life stress associated with immaturity have significant prevailing short-and long-term morbidities. Oxygen dysregulation in the first few days and weeks after birth is a primary concern as the cardiorespiratory system slowly adjusts to extrauterine life. Infants exposed to rapid alterations in oxygen tension, including exposures to hypoxia and hyperoxia, have altered redox balance and active immune signalling, leading to altered stress responses that impinge on neurodevelopment and cardiorespiratory homeostasis. In this review, we explore the clinical challenges posed by preterm birth, followed by an examination of the literature on animal models of oxygen dysregulation and immune activation in the context of early-life stress.

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Clamping the Umbilical Cord in Premature Deliveries (CUPiD): Neuromonitoring in the Immediate Newborn Period in a Randomized, Controlled Trial of Preterm Infants Born at <32 Weeks of Gestation

Cited by 28 publications

References 28 publications

Association between Regional Tissue Oxygenation and Body Temperature in Term and Preterm Infants Born by Caesarean Section

Association between Regional Tissue Oxygenation and Body Temperature in Term and Preterm Infants Born by Caesarean Section

Umbilical cord milking in preterm infants: a systematic review and meta-analysis

The impact of preterm adversity on cardiorespiratory function

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