Intact cord resuscitation versus early cord clamping in the treatment of depressed newborn infants during the first 10 minutes of birth (Nepcord III) – a randomized clinical trial

Andersson, Ola; Rana, Nisha; Ewald, Uwe; Målqvist, Mats; Stripple, Gunilla; Basnet, Omkar; Subedi, Kalpana; Kc, Ashish

doi:10.1186/s40748-019-0110-z

Cited by 63 publications

(90 citation statements)

References 36 publications

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“…However, numerous randomized controlled trials have already demonstrated the benefits of DCC and the potentially harmful effects of ECC (8,21). Recent studies have supported the findings, both for vigorous and nonvigorous infants (15,22,26). This study translates the findings from previous research into clinical practice.…”

Section: Strengths and Limitationssupporting

confidence: 61%

Neonatal transitional support with intact umbilical cord in assisted vaginal deliveries: A quality-improvement cohort study

Sæther

Gülpen

Jensen

et al. 2020

Preprint

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Background: Deferring cord clamping has proven benefits for both term and preterm infants, and recent studies have demonstrated better cardio-respiratory stability if clamping is based on the infant’s physiology, and whether the infant has breathed. Nevertheless, current guidelines for neonatal resuscitation still recommend early cord clamping (ECC) for compromised babies, unless equipment and competent personnel to resuscitate the baby are available at the mother’s bedside. The objective of this quality improvement cohort study was to evaluate whether implementing a new delivery room protocol involving mobile resuscitation equipment (LifeStart™) reduced the prevalence of ECC in assisted vaginal deliveries.Methods: Data on cord clamping and transitional care were collected 8 months before and 8 months after implementing the new protocol. The Improvement Model was applied to identify drivers and obstacles to practice change. Statistical Process Control analysis was used to demonstrate signals of improvement, and whether these changes were sustainable. Multivariate logistic regression was used to evaluate the impact of the new protocol on the primary outcome, adjusted for possible confounders.Results: Overall prevalence of ECC dropped from 13 to 1% (P < 0.01), with a 98% relative risk reduction for infants needing transitional support on a resuscitation table (adjusted OR 0.02, P < 0.001). Mean cord clamping time increased by 43% (p < 0.001). Although fewer infants were placed directly on mothers’ chest (n=43 [42%] vs n=69 [75.0 %], P < 0.001), there were no significant differences in needs for immediate transitional care or transfers to Neonatal Intensive Care Unit. A pattern of improvement was seen already before the intervention, especially after mandatory educational sessions and cross-professional simulation training.Conclusions: A new delivery-room protocol involving mobile resuscitation equipment successfully eliminated early cord clamping in assisted vaginal deliveries of term and near-term infants. A systematic approach, like the Improvement Model, seemed crucial for both achieving and sustaining the desired results.Trial registration: The study was approved as a service evaluation as defined by the Regional Committee for Medical and Health Research Ethics (2018/1755/REK midt).

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Section: Strengths and Limitationssupporting

confidence: 61%

Neonatal transitional support with intact umbilical cord in assisted vaginal deliveries: A quality-improvement cohort study

Sæther

Gülpen

Jensen

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…However, numerous randomized controlled trials have already demonstrated the benefits of DCC and the potentially harmful effects of ECC [8,21]. Recent studies have supported the findings, both for vigorous and non-vigorous infants [15,22,26]. This study translates the findings from previous research into clinical practice.…”

Section: Strengths and Limitationssupporting

confidence: 60%

“…However, ventilation support and full resuscitation can be done without separating mother and baby [22,26]. For hospital settings, mobile bed-side resuscitation equipment (ex.…”

Section: Introductionmentioning

confidence: 99%

Neonatal transitional support with intact umbilical cord in assisted vaginal deliveries: a quality-improvement cohort study

Sæther

Gülpen

Jensen

et al. 2020

BMC Pregnancy Childbirth

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Background: Deferring cord clamping has proven benefits for both term and preterm infants, and recent studies have demonstrated better cardio-respiratory stability if clamping is based on the infant's physiology, and whether the infant has breathed. Nevertheless, current guidelines for neonatal resuscitation still recommend early cord clamping (ECC) for compromised babies, unless equipment and competent personnel to resuscitate the baby are available at the mother's bedside. The objective of this quality improvement cohort study was to evaluate whether implementing a new delivery room protocol involving mobile resuscitation equipment (LifeStart™) reduced the prevalence of ECC in assisted vaginal deliveries. Methods: Data on cord clamping and transitional care were collected 8 months before and 8 months after implementing the new protocol. The Model for Improvement was applied to identify drivers and obstacles to practice change. Statistical Process Control analysis was used to demonstrate signals of improvement, and whether these changes were sustainable. Multivariate logistic regression was used to evaluate the impact of the new protocol on the primary outcome, adjusted for possible confounders. Results: Overall prevalence of ECC dropped from 13 to 1% (P < 0.01), with a 98% relative risk reduction for infants needing transitional support on a resuscitation table (adjusted OR 0.02, P < 0.001). Mean cord clamping time increased by 43% (p < 0.001). Although fewer infants were placed directly on mothers' chest (n = 43 [42%] vs n = 69 [75.0%], P < 0.001), there were no significant differences in needs for immediate transitional care or transfers to Neonatal Intensive Care Unit. A pattern of improvement was seen already before the intervention, especially after mandatory educational sessions and cross-professional simulation training. Conclusions: A new delivery-room protocol involving mobile resuscitation equipment successfully eliminated early cord clamping in assisted vaginal deliveries of term and near-term infants. A systematic approach, like the Model for Improvement, seemed crucial for both achieving and sustaining the desired results.

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“…The NRP does not recommend delayed cord clamping in asphyxiated newborns (6). However, recent studies suggest that in term infants, resuscitation with an intact umbilical cord is associated with a better recovery than routine resuscitation and that umbilical cord milking appears to be a safe therapy when resuscitation is needed (13)(14)(15).…”

Section: Discussionmentioning

confidence: 99%

Intrapartum Asphyxiated Newborns Without Fetal Heart Rate and Cord Blood Gases Abnormalities: Two Case Reports of Shoulder Dystocia to Reflect Upon

Ancora

Meloni

Soffritti³

et al. 2020

Front. Pediatr.

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Our report covers two cases of severe hypoxic-ischemic encephalopathy in newborns whose birth was complicated by shoulder dystocia. In both cases, there were inconsistencies observed among cardiotocographic traces, baby's clinical conditions at birth, and umbilical cord blood gases. Namely, normal cardiotocographic monitoring and cord pH > 7, in spite of the fact that the newborns were severely depressed at birth and their blood gases evaluated within 1 h from birth showed a severe metabolic acidosis. Moreover, one of the two newborns displayed moderately low hemoglobin levels. Metabolic and infectious causes were ruled out. Both newborns developed severe hypoxic-ischemic encephalopathy and received therapeutic hypothermia for 72 h. Both survived, one with a severe dystonic cerebral palsy whereas the other developed only a mild developmental delay in language. Cardiac asystole theory could explain these two cases, reinforcing the need for specific resuscitation guidelines for infants experiencing a birth complicated by shoulder dystocia.

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Intact cord resuscitation versus early cord clamping in the treatment of depressed newborn infants during the first 10 minutes of birth (Nepcord III) – a randomized clinical trial

Cited by 63 publications

References 36 publications

Neonatal transitional support with intact umbilical cord in assisted vaginal deliveries: A quality-improvement cohort study

Neonatal transitional support with intact umbilical cord in assisted vaginal deliveries: A quality-improvement cohort study

Neonatal transitional support with intact umbilical cord in assisted vaginal deliveries: a quality-improvement cohort study

Intrapartum Asphyxiated Newborns Without Fetal Heart Rate and Cord Blood Gases Abnormalities: Two Case Reports of Shoulder Dystocia to Reflect Upon

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