Placental Transfusion: Umbilical Cord Clamping and Preterm Infants

Abstract

OBJECTIVE:To investigate the clinical effects of early versus late cord clamping in preterm infants. STUDY DESIGN:A total of 32 premature infants were prospectively randomized. The following parameters were measured: Initial spun hematocrit (Hct), hemoglobin (Hgb), red blood cell (RBC) counts, frequency of blood transfusions, peak serum bilirubin, mean blood pressure (MBP), oxygen index, intraventricular hemorrhage, and significant patent ductus arteriosus (PDA). RESULTS:Over the 4-week study period, the delayed cord clamping (DCC) group exhibited a decrease in the frequency of blood transfusion (p Ͻ 0.001) and also a decrease in albumin transfusions over the first 24 hours (p Ͻ 0.03). MBP in the first 4 hours was higher in the DCC group (p Ͻ 0.01), and there were statistically significant increases in Hct (21%), Hgb (23%), and RBC count (21%) compared with the early cord clamping group. The risks of patent ductus arteriosus, hyperbilirubinemia, or intraventricular hemorrhage were similar in both groups. Late clamping of the umbilical cord had little or no effect on the oxygen index. CONCLUSION:DCC significantly reduced the requirement for blood and albumin transfusion. It also increased the initial Hct, RBC count, Hgb levels, and MBP.

The effect of early and late umbilical cord clamping on neonatal hematocrit

“…Most of the placental transfusion takes place in the first 3 min after birth; 50 to 70% of the volume transfuses in the first minute. 1 Previous studies regarding the delayed cord clamping have had mixed results. Several did not show a significant difference in hematocrit of neonates between the ECC and LCC groups, 2,9 whereas others demonstrated a marked rise hematocrit during the first hours of neonatal life in the LCC group.…”

“…No prior studies have reported findings about polycythemia in these neonates. 1,10 The question of early versus late umbilical cord clamping is still unanswered. This study was designed to compare the effect of early and late umbilical cord clamping on neonatal hematocrit.…”

“…As otherwise, the child is much weaker than it ought to be, a part of the blood being left in the placenta, which ought to have been in the child.' 1 ECC at birth has become a routine procedure. This may deprive neonates of significant blood volume and can cause neonatal short-term and long-term potential problems such as respiratory distress, anemia and cerebral pulsy and mental retardation.…”

Umbilical Cord Clamping Time in Premature Infants

“…Although most of the studies in the literature have found higher haemoglobin and haematocrit levels in delayed clamping groups, some studies have reported no difference [7,8].…”

“…Many studies have shown that delayed cord clamping leads to remarkable decreases in risks of morbidity such as intraventricular haemorrhage and necrotising enterocolitis in preterm infants. Delayed cord clamping provides an additional 20 to 30 ml of blood from the placenta to the infant and this additional blood volume is linked with neonatal benefits including better systemic pressure, a reduced need for inotropic support and fewer blood transfusions [1][2][3][4][5][6][7][8][9].…”