Mask Continuous Positive Airway Pressure Therapy with Simultaneous Extrauterine Placental Transfusion for Resuscitation of Preterm Infants – A Preliminary Study

Abstract

Background: Delayed cord clamping or cord milking improves cardiovascular stability and outcome of preterm infants. However, both techniques may delay initiation of respiratory support. To allow lung aeration during cord blood transfusion, we implemented an extrauterine placental transfusion (EPT) approach. This study aimed to provide a detailed description of the EPT procedure and to evaluate its impact on the outcome of infants. Methods: A retrospective analysis was performed comprising 60 preterm infants (22^0/7 to 31^6/7 weeks of gestation). Of these, 40 were transferred to the resuscitation unit with the placenta still connected to the infant. In this EPT group, continuous positive airway pressure support was initiated while, simultaneously, placental blood was transfused by holding the placenta 40-50 cm above the infant's heart. The cords of another 20 infants were clamped before respiratory support was started (standard group). Data on the infants' outcome were compared retrospectively. In a subgroup of 22 infants (n = 14 EPT, n = 8 standard), respiratory function monitor recordings were performed and both heart rates and SpO₂ levels in the first 10 min of life were compared between groups. Results: Although infants in the EPT group were lighter (EPT: 875 ± 355 g, standard: 1,117 ± 389 g; p = 0.02) and younger (26^6/7 weeks ± 19 days vs. 28^2/7 weeks ± 18 days; p = 0.045), there was no difference in neonatal outcome, including the incidence of intraventricular hemorrhage, bronchopulmonary disease, and red blood cell transfusions (all p > 0.1). Moreover, no differences in SpO₂ levels and heart rates were observed in the infants whose resuscitations were recorded using a respiratory function monitor. Conclusions: In this retrospective analysis, EPT had no negative effects on the outcome of the infants, which warrants further evaluation in prospective randomized studies.

Low incidence of acute kidney injury in VLBW infants with restrictive use of mechanical ventilation

“…Our center offers active care to families from 22 weeks of gestation [ 18 ] using a very specific DR protocol that comprises an extensive care bundle to avoid MV within the first 72 hours of life [ 19 ]. In summary, this approach focusses on the establishment of spontaneous breathing using a stepwise increasing positive end-expiratory pressure (PEEP) strategy in line with the most recent ERC guidelines [ 20 ], less invasive surfactant application (LISA) and the avoidance of MV using a variety of non-invasive ventilation strategies [ 19 , 21 ]. In detail, the baby receives sustained continuous positive airway pressure (CPAP) to recruit lung volume immediately after birth via a face mask with a variable flow CPAP device (Benveniste valve, Dameca, Copenhagen, Denmark) [ 22 ] using a flow of humidified gas.…”

Physiologiebasierte Erstversorgung sehr kleiner Frühgeborener

“…Alternative Methoden zum sog. "physiological based cord clamping", die eine respiratorische Versorgung des Kindes bei erhaltener plazentarer Perfusion neben der Mutter erlauben [5,6] oder bei denen das Kind bei einer Sectio zusammen mit der Plazenta entwickelt und zur Erstversorgungseinheit gebracht wird, damit die Abnabelung dort erst nach Auspulsieren der Nabelschnur erfolgen kann [7], wurden berichtet und sind sicher durchführbar, haben aber bislang noch keinen breiten Einsatz in der klinischen Praxis gefunden.…”

Optimizing Cord Clamping in Preterm Infants: One Strategy Does Not Fit All

“…Another broad strategy is that of milking the cord either before or after it is cut. Removal of the baby and placenta together and resuscitation with the placenta attached is also being trialed (19).…”