Physiologically based cord clamping stabilises cardiac output and reduces cerebrovascular injury in asphyxiated near-term lambs

Polglase, Graeme R.; Blank, Douglas A; Barton, Samantha K.; Miller, Stephanie; Stojanovska, Vanesa; Kluckow, Martin; Gill, Andrew; LaRosa, Domenic A.; Pas, Arjan B. te; Hooper, Stuart B.

doi:10.1136/archdischild-2017-313657

Cited by 61 publications

(88 citation statements)

References 34 publications

(13 reference statements)

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“…When severely asphyxiated lambs were ventilated and resuscitated using PBCC, the low resistance placental vascular bed greatly mitigated the rebound hypertension that occurs after restoration of circulation compared to lambs that had ICC [36]. This led to less cerebrovascular injury in PBCC lambs compared to ICC lambs, although clamping in the middle of rebound response appeared to make things worse.…”

Section: The Umbilical Cordmentioning

confidence: 99%

“…Experimental lamb studies have shown that PBCC may not only be beneficial for preterm infants, but could also benefit infants suffering from asphyxia and infants with congenital diaphragmatic hernia [36]. When severely asphyxiated lambs were ventilated and resuscitated using PBCC, the low resistance placental vascular bed greatly mitigated the rebound hypertension that occurs after restoration of circulation compared to lambs that had ICC [36].…”

Section: The Umbilical Cordmentioning

confidence: 99%

See 1 more Smart Citation

The Changing Landscape in Supporting Preterm Infants at Birth

2019

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Noninvasive ventilation for preterm infants at birth has been recommended and universally adopted. The umbilical cord is often clamped immediately in order to provide the support the infant needs for stabilization. However, recent scientific data from experimental studies that involve animals in transition and human studies using physiological measurements at birth have increased awareness as to how little we know about how these interventions interact and integrate with the infant’s changing physiology. It has become clear that in apneic infants the larynx is closed immediately after birth, which can completely negate the effect of noninvasive ventilation of the lung. For this reason, stimulating and supporting spontaneous breathing could enhance the success of noninvasive ventilation. Animal data also demonstrated that the large swings in blood pressure, blood flow, and oxygenation caused by immediate cord clamping can be avoided by postponing cord clamping until lung aeration has been established. In this review we will focus on these “game changers” that have the potential to completely change the approach used in stabilizing preterm infants at birth.

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Section: The Umbilical Cordmentioning

confidence: 99%

Section: The Umbilical Cordmentioning

confidence: 99%

The Changing Landscape in Supporting Preterm Infants at Birth

2019

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“…Another factor that may affect placental transfusion is the onset of infants’ ventilation. In an animal model, DCC until ventilation onset increases pulmonary blood flow, improves cardiovascular function, stabilizes systemic and cerebral oxygenation, and reduces cerebrovascular injury [20, 21]. Since the time of the onset of infants’ breathing was not collected in our study and no positive pressure ventilation was provided during DCC, the inadequacy of ventilation of the infants in the DCC group during the procedure may have contributed to our results.…”

Section: Discussionmentioning

confidence: 38%

A Randomized Controlled Trial of Immediate versus Delayed Umbilical Cord Clamping in Multiple-Birth Infants Born Preterm

et al. 2018

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Background: Delayed cord clamping (DCC) improves placental transfusion and increases blood volume in preterm infants when compared with immediate cord clamping (ICC). However, evidence to support DCC in multiple-birth preterm infants is still lacking. Objective: To compare the outcomes of ICC versus DCC in preterm infants of multiple births. Study Design: Women with a multiple pregnancy, including twins and triplets with a gestational age of 28–36 weeks, were randomized to receive ICC (23 women and 50 infants) or DCC for 30–60 s (24 and 51 infants). The infants’ hematocrit on admission, superior vena cava (SVC) flow measured within 24 h, and hematocrit at 8 weeks of age were compared. The use of uterotonic agents during delivery was not controlled in this study. Result: All infants were delivered by cesarean section (CS) except for 2 sets of twins, 1 in each group. Maternal and infant baseline characteristics in both groups were comparable. There were no significant differences between the groups in admission hematocrit, SVC flow measured within 24 h, hematocrit at 8 weeks of age, or any other neonatal outcomes. The incidence of maternal postpartum hemorrhage (PPH) was higher in the DCC group (4.3% in ICC vs. 25% in DCC, p = 0.04). Conclusion: DCC for 30–60 s did not improve placental transfusion or increase systemic blood flow in multiple-birth infants born preterm, mostly by CS, when compared with ICC. The finding of a higher PPH rate in the DCC group raises concerns about the maternal safety of this procedure in this patient population.

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“…If the placental circulation remains intact until pulmonary blood flow is established, physiologically-based cord clamping (PBCC), then haemodynamic compromise is minimised and insult to the LV reduced 70. PBCC has also been shown to confer advantages in the asphyxiated animal model 71. The translation of these findings to clinical practice has been hampered by a focus on a placental transfusion and delayed cord clamping without emphasis on establishing a pulmonary circulation; nevertheless, results are encouraging with a reduction in mortality and a trend towards reduced P/IVH and needs for circulatory support 72.…”

Section: Discussionmentioning

confidence: 99%

Postnatal cardiovascular adaptation

Gill

2018

Arch Dis Child Fetal Neonatal Ed

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The heart undergoes rapid transformations in function during the transition to extrauterine life. Our understanding of the adaptive physiology underlying this process is able to inform the clinical management of infants who are struggling to complete this complex transition. Much of our knowledge of the cardiac transition is derived from the preterm infant in whom the preparative adaptations are incomplete and clinical sequelae all too common. This review will re-examine the cardiac transition highlighting the physiology that drives it and suggest appropriate clinical intervention to support the process.

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Physiologically based cord clamping stabilises cardiac output and reduces cerebrovascular injury in asphyxiated near-term lambs

Cited by 61 publications

References 34 publications

The Changing Landscape in Supporting Preterm Infants at Birth

The Changing Landscape in Supporting Preterm Infants at Birth

A Randomized Controlled Trial of Immediate versus Delayed Umbilical Cord Clamping in Multiple-Birth Infants Born Preterm

Postnatal cardiovascular adaptation

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