Does physiological-based cord clamping improve cerebral tissue oxygenation and perfusion in healthy term neonates? – A randomized controlled trial

Abstract

ObjectivesTo evaluate cerebral tissue oxygenation index (cTOI) during neonatal transition in a group of healthy full-term neonates receiving either a physiological-based approach of deferred cord clamping (CC) after the onset of stable regular breathing (PBCC group) or a standard approach of time-based CC < 1 min (control group). Secondary aim was to evaluate changes in cerebral blood volume (ΔCBV), peripheral arterial oxygen saturation (SpO2) and heart rate (HR) in those neonates.Materials and MethodsWe conducted a randomized controlled trial (clinicaltrials.gov: NCT02763436) including vaginally delivered healthy full-term neonates. Continuous measurements of cTOI and ΔCBV using near-infrared spectroscopy, and of SpO2 and HR using pulse oximetry were performed within the first 15 min after birth. Data of each minute of the PBCC group were compared to those of the control group.ResultsA total of 71 full-term neonates (PBCC: n = 35, control: n = 36) with a mean (SD) gestational age of 40.0 (1.0) weeks and a birth weight of 3,479 (424) grams were included. Median (IQR) time of CC was 275 (197–345) seconds and 58 (35–86) seconds in the PBCC and control group, respectively (p < 0.001). There were no significant differences between the two groups regarding cTOI (p = 0.319), ΔCBV (p = 0.814), SpO2 (p = 0.322) and HR (p = 0.878) during the first 15 min after birth.ConclusionThere were no significant differences in the course of cTOI as well as ΔCBV, SpO2 and HR during the first 15 min after birth in a group of healthy full-term neonates, who received either deferred CC after the onset of stable regular breathing or standard CC < 1 min. Thus, deferring CC ≥ 1 min following a physiological-based approach offers no benefits regarding cerebral tissue oxygenation and perfusion after uncomplicated vaginal delivery compared to a time-based CC approach.

Extended period of ventilation before delayed cord clamping augments left‐to‐right shunting and decreases systemic perfusion at birth in preterm lambs

“…This similarity of global parameters is in accord with the few available clinical reports, wherein little or no difference was present between PBCC (i.e. DCC preceded by an extended 4-5 min period of initial ventilation) and conventional DCC with 1 min of prior ventilation, with respect to changes in heart rate and peripheral arterial oxygenation (via pulse oximetry) in term infants (Schwaberger et al, 2022) or short-term neonatal outcomes in very preterm (<32 weeks gestation) infants (Knol et al, 2020).…”

Blood pressure and cerebral oxygenation with physiologically-based cord clamping: sub-study of the BabyDUCC trial

“…4,5 With regards to cerebral oxygenation in the delivery room, a recent RCT found no differences between PBCC and ECC in vaginally-born, full-term neonates not needing resuscitation. 28 Our findings were similar in a population that received resuscitation and included caesarean births. In contrast, Katheria et al found that at 12 h after birth, cerebral oxygen saturation and BP were higher among term infants at risk of needing resuscitation who were randomised to UCC at 5 min versus within 1 min after birth.…”

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

“…With regards to cerebral oxygenation in the delivery room, a recent RCT found no differences between PBCC and ECC in vaginally-born, full-term neonates not needing resuscitation. 27 Our findings were similar in a population that received resuscitation and included caesarean births. In contrast, Katheria et al found that at 12 hours after birth, cerebral oxygen saturation and BP were higher among term infants at risk of needing resuscitation who were randomised to UCC at 5 min versus within 1 min after birth.…”