Neonatal Outcome Following Cord Clamping After Onset of Spontaneous Respiration

Abstract

BACKGROUND AND OBJECTIVE: Evolving data indicate that cord clamping (CC) beyond 30 to 60 seconds after birth is of benefit for all infants. Recent experimental data demonstrated that ventilation before CC improved cardiovascular stability by increasing pulmonary blood flow. The objective was to describe the relationship between time to CC, onset of spontaneous respirations (SR), and 24-hour neonatal outcome. METHODS: In a rural Tanzanian hospital, trained research assistants, working in shifts, have observed every delivery (November 2009–February 2013) and recorded data including time interval from birth to SR and CC, fetal heart rate, perinatal characteristics and outcome (normal, death, admission). RESULTS: Of 15 563 infants born, 12 780 (84.3%) initiated SR at 10.8 ± 16.7 seconds, and CC occurred at 63 ± 45 seconds after birth. Outcomes included 12 730 (99.7%) normal, 31 deaths, and 19 admitted; 11 967 were of birth weight (BW) ≥2500 g and 813 <2500 g. By logistic modeling, the risk of death/admission was consistently higher if CC occurred before SR. Infants of BW <2500 g were more likely to die or be admitted. The risk of death/admission decreased by 20% for every 10-second delay in CC after SR; this risk declined at the same rate in both BW groups. CONCLUSIONS: Healthy self-breathing neonates are more likely to die or be admitted if CC occurs before or immediately after onset of SR. These clinical observations support the experimental findings of a smoother cardiovascular transition when CC is performed after initiation of ventilation.

Normal Newborn Heart Rate in the First Five Minutes of Life Assessed by Dry-Electrode Electrocardiography

“…We speculate that the reason for the brief minor changes in HR is the establishment of pulmonary circulation following the onset of breathing prior to cord clamping in all cases. This is consistent with our recent report of a 20% reduction in newborn mortality for every 10-second delay in cord clamping following the onset of breathing [9], and experimental observations describing a smoother cardiovascular transition when cord clamping have been noted following ventilator support [8]. …”

“…Cord clamping may initiate a physiological decrease in cardiac output by decreasing the preload and increasing the after-load, which could lead to changes in HR and circulatory instability, particularly in nonbreathing newborns [8]. Recent evidence points to the importance of delaying cord clamping until after the onset of breathing [8,9]. The impact of cord clamping on the HR when performed following the onset of breathing remains unclear.…”

Frequent brief on-site simulation training and reduction in 24-h neonatal mortality—An educational intervention study

“…Indeed, we recently demonstrated that the risk of death/admission decreased by 20% for every 10-s delay in cord clamping after spontaneous respirations [23]. In this report the majority of deaths occurred in infants who received BMV, a different population., There are several limitations to our study.…”

Timing of umbilical cord clamping of term infants

“…A s t u d y c o n d u c t e d i n A f r i c a i n a n extensive cohort of 15 563 NBIs 28 reviewed the relationship between cord clamping timing and the spontaneous onset of breath and infants' clinical course in the first 24 hours of life. Results showed that the risk of death or postdischarge readmission was higher when the cord was clamped before the first breath and that such risk decreased by approximately 20% per every additional 10 seconds lapsed until cord clamping.…”