Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes

Abstract

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Inotropes for preterm babies during the transition period after birth: friend or foe?

“…A Cochrane review,49 on the effects of delayed cord clamping in preterm infants reported benefits of higher blood pressure in the first days of life, less need for volume therapy or inotropes as short-term outcomes and less need for blood transfusions. A recent meta-analysis for preterm infants <30 weeks gestation and <1000 g birth weight confirmed these benefits for this very high-risk group 50.…”

Strategies for implementing placental transfusion at birth: A systematic review

“…3,4 A recently published meta-analysis calculated a 30% increase in hospital deaths for preterm infants who had their cords clamped immediately after birth. In preterm infants, it reduces the number of blood transfusions, incidence of necrotizing enterocolitis, intraventricular hemorrhage, and mortality.…”

“…3,4 A recently published meta-analysis calculated a 30% increase in hospital deaths for preterm infants who had their cords clamped immediately after birth. 3,5,9,10 However, this simple, effective, and cost-free evidence-based practice is not widely adopted, potentially impacting a newborn for life. [6][7][8] While there was some initial clinical concern with respect to potential increased risk of jaundice requiring phototherapy and increased rates of postpartum hemorrhage, evidence exists to shift these clinicians' perceptions.…”

Timing is everything

“…A meta-analysis of 15 small studies comparing early (<30 s) versus late (30–180 s) cord clamping in preterm infants demonstrated a decrease in hypotension, intraventricular haemorrhage, necrotising enterocolitis and number of transfusions, as well as an increase in haematocrit and blood volume 1. The authors concluded that the meta-analysis was inconclusive due to several biases—preterm infants needing resuscitation were excluded from all the studies, for example—and considerable variation in methods 1.…”

“…The authors concluded that the meta-analysis was inconclusive due to several biases—preterm infants needing resuscitation were excluded from all the studies, for example—and considerable variation in methods 1. More research therefore needs to be done.…”