Delayed cord clamping in Rh-alloimmunised infants: a randomised controlled trial

Sahoo, Tanushree; Thukral, Anu; Sankar, Mari Jeeva; Gupta, Saurabh Kumar; Agarwal, Ramesh; Deorari, Ashok K.; Paul, Vinod K.

doi:10.1007/s00431-020-03578-8

Cited by 12 publications

(6 citation statements)

References 28 publications

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“…The same applies to mothers with human immunodeficiency virus infection and low viral load as transmission from mother to fetus is very low [49]. A study of mother-infant pairs with Rhesusalloimmunisation demonstrated that infants who received placental transfusion at delivery had reduced need for immediate blood exchange transfusion after birth and were successfully managed with phototherapy and blood transfusions as needed [50].…”

Section: Potential Fetal Risk Conditionsmentioning

confidence: 99%

What does the evidence tell us? Revisiting optimal cord management at the time of birth

Rabe

Mercer

2022

Eur J Pediatr

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A newborn who receives a placental transfusion at birth from delayed cord clamping (DCC) obtains about 30% more blood volume than those with immediate cord clamping (ICC). Benefits for term neonates include higher hemoglobin levels, less iron deficiency in infancy, improved myelination out to 12 months, and better motor and social development at 4 years of age especially in boys. For preterm infants, benefits include less intraventricular hemorrhage, fewer gastrointestinal issues, lower transfusion requirements, and less mortality in the neonatal intensive care unit by 30%. Ventilation before clamping the umbilical cord can reduce large swings in cardiovascular function and help to stabilize the neonate. Hypovolemia, often associated with nuchal cord or shoulder dystocia, may lead to an inflammatory cascade and subsequent ischemic injury. A sudden unexpected neonatal asystole at birth may occur from severe hypovolemia. The restoration of blood volume is an important action to protect the hearts and brains of neonates. Currently, protocols for resuscitation call for ICC. However, receiving an adequate blood volume via placental transfusion may be protective for distressed neonates as it prevents hypovolemia and supports optimal perfusion to all organs. Bringing the resuscitation to the mother’s bedside is a novel concept and supports an intact umbilical cord. When one cannot wait, cord milking several times can be done quickly within the resuscitation guidelines. Cord blood gases can be collected with optimal cord management. Conclusion: Adopting a policy for resuscitation with an intact cord in a hospital setting takes a coordinated effort and requires teamwork by obstetrics, pediatrics, midwifery, and nursing. What is Known:• Placental transfusion through optimal cord management benefits morbidity and mortality of newborn infants.• The World Health Organisation has recommended placental transfusion in their guidance. What is New:• Improved understanding of transitioning to extrauterine life has been described.• Resuscitation of newborn infants whilst the umbilical cord remains intact could improve the postpartum adaptation.

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Section: Potential Fetal Risk Conditionsmentioning

confidence: 99%

What does the evidence tell us? Revisiting optimal cord management at the time of birth

Rabe

Mercer

2022

Eur J Pediatr

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“…Compared with early cord clamping, delayed cord clamping was associated with a higher hematocrit 2 hours after delivery (mean difference 4.9%; 95% CI 0.6-9.1, P5.03), without significant differences in the duration of phototherapy, requirement for partial exchange and double volume exchange transfusion, hemodynamic parameters based on functional echocardiography in initial 12 hours after delivery, and blood transfusion requirements until 14 weeks of age. 64 Although these preliminary studies suggest that delayed cord clamping may be beneficial in the setting of alloimmunization, additional large multicenter studies including neonates with severe anemia and hydrops with long-term neurodevelopmental follow-up are needed.…”

Section: Red Blood Cell Alloimmunizationmentioning

confidence: 99%

Management of Placental Transfusion to Neonates After Delivery

McAdams

Lakshminrusimha

2021

Obstetrics &Amp; Gynecology

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This review summarizes high-quality evidence supporting delayed umbilical cord clamping to promote placental transfusion to preterm and term neonates. In preterm neonates, delayed cord clamping may decrease mortality and the need for blood transfusions. Although robust data are lacking to guide cord management strategies in many clinical scenarios, emerging literature is reviewed on numerous topics including delivery mode, twin gestations, maternal comorbidities (eg, gestational diabetes, red blood cell alloimmunization, human immunodeficiency virus [HIV] infection, and severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and neonatal complications (eg, fetal growth restriction, congenital heart disease, and the depressed neonate). Umbilical cord milking is an alternate method of rapid placental transfusion, but has been associated with severe intraventricular hemorrhage in extremely preterm neonates. Data on long-term outcomes are discussed, as well as potential contraindications to delayed cord clamping. Overall, delayed cord clamping offers potential benefits to the estimated 140 million neonates born globally every year, emphasizing the importance of this simple and no-cost strategy.

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“…The PRISMA flow is shown in online supplementary Figure 1. Of the included RCTs, 18 enrolled 2,253 newborns born at <34 weeks of gestation [25, 27-33, 36, 38, 41, 43-45, 47-50] and 9 enrolled 883 LPT newborns [24, 26, 34, 35, 37, 39, 40, 42, 46]. Intransitivity was assessed by comparing the characteristics of included studies.…”

Section: Resultsmentioning

confidence: 99%

“…Of the 27 included RCTs, 7 had a low ROB [25, 26, 36, 38, 39, 42, 45]. While 6 RCTs had some concerns [27, 31, 33, 37, 40, 43], 14 had a high ROB [24, 28-30, 32, 34, 35, 41, 44-50].…”

Section: Resultsmentioning

confidence: 99%

Placental Transfusion Strategies in Preterm Infants in Low- and Middle-Income Countries: A Systematic Review and Network Meta-Analysis

et al. 2022

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Introduction: Placental transfusion strategies in preterm newborns have not been evaluated in low- and middle-income countries (LMICs). The objective of this systematic review was to compare placental transfusion strategies in preterm newborns in LMICs, including delayed cord clamping (DCC) for various time intervals, DCC until cord pulsations stop, umbilical cord milking, and immediate cord clamping (ICC). Methods: Medline, Embase, CINAHL, and CENTRAL were searched from inception. Observational studies and randomized controlled trials (RCTs) were included. Two authors independently extracted data for Bayesian random-effects network meta-analysis (NMA) if more than 3 interventions reported an outcome or a pairwise meta-analysis was utilized. Results: Among newborns <34 weeks of gestation, NMA of 9 RCTs could not rule out benefit or harm for survival from DCC 30–60 s compared to ICC: relative risk (RR) (95% credible interval) 0.96 (0.78–1.12), moderate certainty, or any included strategy compared to each other (low to very low certainty). Among late preterm newborns, DCC 120 s might be associated with improved survival: RR (95% confidence interval) 1.11 (1.01–1.22), very low certainty. We could not detect differences in the risk of intraventricular hemorrhage grade > II and bronchopulmonary dysplasia for any included intervention (low to very low certainty). DCC 60 s and 120 s might improve the hematocrit level among all preterm newborns (very low certainty), and DCC 45 s may decrease the risk of receipt of inotropes among newborns <34 weeks of gestation (low certainty). Conclusions: In LMICs, DCC for 60 s and 120 s might improve hematocrit level in preterm newborns, and DCC for 45 s may decrease the risk of receipt of inotropes in newborns <34 weeks, with no conclusive effect on survival.

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Delayed cord clamping in Rh-alloimmunised infants: a randomised controlled trial

Cited by 12 publications

References 28 publications

What does the evidence tell us? Revisiting optimal cord management at the time of birth

What does the evidence tell us? Revisiting optimal cord management at the time of birth

Management of Placental Transfusion to Neonates After Delivery

Placental Transfusion Strategies in Preterm Infants in Low- and Middle-Income Countries: A Systematic Review and Network Meta-Analysis

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