Placental Transfusion and Cardiovascular Instability in the Preterm Infant

Abstract

Postnatal adaptation in preterm newborn comprises complex physiological processes that involve significant changes in the circulatory and respiratory system. Increasing hemoglobin level and blood volume following placental transfusion may be of importance in enhancing arterial oxygen content, increasing cardiac output, and improving oxygen delivery. The European consensus on resuscitation of preterm infants recommends delayed cord clamping (DCC) for at least 60 s to promote placenta–fetal transfusion in uncompromised neonates. Recently, published meta-analyses suggest that DCC is associated with fewer infants requiring transfusions for anemia, a lower incidence of intraventricular hemorrhage, and lower risk for necrotizing enterocolitis. Umbilical cord milking (UCM) has the potential to avoid some disadvantages associated with DCC including the increased risk of hypothermia or delay in commencing manual ventilation. UCM represents an active form of blood transfer from placenta to neonate and may have some advantages over DCC. Moreover, both methods are associated with improvement in hemodynamic parameters and blood pressure within first hours after delivery compared to immediate cord clamping. Placental transfusion appears to be beneficial for the preterm uncompromised infant. Further studies are needed to evaluate simultaneous placental transfusion with resuscitation of deteriorating neonates. It would be of great interest for future research to investigate advantages of this approach further and to assess its impact on neonatal outcomes, particularly in extremely preterm infants.

Effectiveness and safety of umbilical cord milking in premature infants: A randomized controlled trial

“…Therefore, to adapt to these changes, preterm infants must have sufficient blood volume at birth to ensure the maintenance of stable blood pressure levels, oxygen supply, and perfusion of tissues and organs. [5] Dipak et al [33] showed that DCC lasting 60 seconds favors elevated blood pressure in preterm infants and thus contributes to improved hemodynamics and organ perfusion in preterm infants. Katheria et al [34] showed that premature blood pressure in the UCM group was higher in the first 15 hours after birth than in the DCC group.…”

“…[1,3,4] Placental blood transfusion can increase iron stores and hemoglobin, reduce blood transfusion demand, and improve postnatal hemodynamic stability in premature infants, thus improving postnatal adaptability. [5][6][7][8] The methods used for placental blood transfusion include delayed cord clamping (DCC) (i.e., slow and passive transfer of blood from the placenta to the newborn via uterine contraction, namely, through the umbilical cord after the umbilical cord pulsation disappears) and umbilical cord milking (UCM) (i.e., active transmission of blood from part of the umbilical cord to the newborn by milking after the fetus is delivered, with a time requirement of 20 seconds). [9][10][11] Although DCC improves anemia in preterm infants and even reduces the risk of death or major disability at 2 years, [12] the disappearance of umbilical cord pulsation requires a waiting time of 1 to 3 minutes, and healthcare workers worry that DCC might delay the timing of premature birth resuscitation.…”

Effect of Novel Placental Transfusion Technique—Gravity-Aided Cord Blood Transfusion at Birth on Hemoglobin Levels in Preterm Infants Born Less than 30 Weeks: A Randomized Controlled Trial

“…It improves the superior vena cava blood flow and right ventricular output, stabilizes the blood pressure, and reduces the need for inotropic support in the first 24 hours. 1 These benefits are more important in preterm neonates as by stabilizing the hemodynamics, preterm neonates are reported to have less intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC). 2 The AAP neonatal resuscitation program (NRP) recommends 30 to 60 seconds of DCC in vigorous preterm and term neonates, and immediate umbilical cord clamping in nonvigorous neonates.…”

The effect of placental transfusion on hemodynamics in premature newborns: a randomized controlled trial

“…Simply, placental transfusion might help in solving the challenging problems of prematurity, consequently, improving morbidities and mortality of preterm infants. (2)(3)(4)(5)(6)(7)(8)(9)(10)(11) There are 3 types of placenta transfusions that are variable in timing, duration and amount of blood transfused. They are Cut-umbilical cord milking(C-UCM), intact umbilical cord milking (I-UCM) and Delayed Cord Clamping (DCC).…”