Effects of delayed cord clamping in intrauterine growth–restricted neonates: a randomized controlled trial

Digal, Kanhu Charan; Singh, Poonam; Srivastava, Yash; Chaturvedi, Jaya; Tyagi, Amit Kumar; Basu, Sriparna

doi:10.1007/s00431-021-03959-7

Cited by 11 publications

(8 citation statements)

References 33 publications

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“…Furthermore, our results revealed no significant difference between studied groups regarding polycythemia. Similarly, Digal and colleagues observed higher venous hematocrit at 24 h of age and higher serum ferritin levels at 3 months of age in IUGR neonates born ≥28 weeks' gestational age managed by deferred cord clamping for 60 s vs. ICC (21). We previously reported that DCC for 60 s in infants with IUGR was associated with greater hemoglobin levels at 2 months of age without higher incidence of polycythemia (16).…”

Section: Discussionmentioning

confidence: 65%

Impact of Umbilical Cord Milking on Hematological Parameters in Preterm Neonates With Placental Insufficiency

et al. 2022

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BackgroundData is still lacking about the expediency of umbilical cord milking (UCM) in preterm neonates born to mothers with placental insufficiency (PI).ObjectiveTo study the effect of UCM in preterm neonates who had ante-natal evidence of placental insufficiency on peripheral blood cluster of differentiation 34 (CD34) percentage, hematological indices, and clinical outcomes.MethodsPreterm neonates, <34 weeks' gestation, born to mothers with evidence of placental insufficiency that underwent UCM (PI+UCM group) were compared with historical controls whose umbilical stumps were immediately clamped [PI+ICC (immediate cord clamping) group] in a case-control study. Peripheral blood CD34 percentage as a measure of hematopoietic stem cell transfusion was the primary outcome. Early and late-onset anemia; polycythemia; frequency of packed red blood cells (PRBCs) transfusion during NICU stay; peak total serum bilirubin (TSB); incidence of phototherapy, admission rectal temperature; first 24 h hypothermia and hypoglycemia; episodes of hypotension and need for volume expander boluses and inotropic support during the first 24 h of age; duration of oxygen therapy; bronchopulmonary dysplasia (BPD); severe intra-ventricular hemorrhage (IVH); necrotizing enterocolitis (NEC); culture-proven late-onset sepsis; length of hospital stay; and in-hospital mortality were secondary outcomes.ResultsIn preterm infants with placental insufficiency, umbilical cord milking was associated with greater peripheral blood CD34 percentage, hemoglobin levels initially and at postnatal age of 2 months, alongside significantly shorter duration of oxygen therapy compared with ICC group. Frequency of packed RBCs transfusion during hospital stay was comparable. Neonates in UCM group had a greater peak TSB level during admission with significantly higher need for phototherapy initiation compared with ICC. Logistic regression, adjusted for gestational age, revealed that UCM resulted in greater CD34 percentage, higher initial hemoglobin level, higher peak serum bilirubin, significant increase of phototherapy initiation, and higher hemoglobin level at 2 months.ConclusionsUCM in preterm neonates born to mothers with placental insufficiency was feasible and resulted in greater CD34 percentage, higher initial hemoglobin level, higher peak serum bilirubin, significant increase of phototherapy initiation, and higher hemoglobin level at 2 months.

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Section: Discussionmentioning

confidence: 65%

Impact of Umbilical Cord Milking on Hematological Parameters in Preterm Neonates With Placental Insufficiency

et al. 2022

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“…79 In a trial of neonates with fetal growth restriction delivered at more than 28 weeks of gestation, compared with early cord clamping (within 30 seconds; n555, mean gestational age 35.963.0 weeks), delayed cord clamping (more than 60 seconds; n555, mean gestational age 36.562.9 weeks) was associated with improved systemic blood flow at 24 hours based on superior vena cava blood flow measurements. 80 Delayed cord clamping was also associated with increased hematocrit at 24 hours of age and serum ferritin levels at 3 months of age without higher incidences of polycythemia or phototherapy requirements for significant hyperbilirubinemia in the newborn period. No differences in major morbidities or mortality were noted between the groups.…”

Section: Fetal Growth Restrictionmentioning

confidence: 94%

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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Effects of delayed cord clamping in intrauterine growth–restricted neonates: a randomized controlled trial

Cited by 11 publications

References 33 publications

Impact of Umbilical Cord Milking on Hematological Parameters in Preterm Neonates With Placental Insufficiency

Impact of Umbilical Cord Milking on Hematological Parameters in Preterm Neonates With Placental Insufficiency

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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