Delayed vs Immediate Cord Clamping Changes Oxygen Saturation and Heart Rate Patterns in the First Minutes after Birth

Padilla-Sánchez, Celia; Baixauli-Alacreu, Susana; Cañada-Martínez, Antonio José; Solaz-García, Álvaro; Alemany-Anchel, María José; Vento, Máximo

doi:10.1016/j.jpeds.2020.07.045

Cited by 49 publications

(31 citation statements)

References 43 publications

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“…Furthermore, Dawson et al 3 reported that the 50th centile heart rate reached a plateau of around 160 bpm at 3 min after birth, whereas our results suggest an early peak of approximately 175 bpm within the first minute after birth, thereafter slowly decreasing. The recent study of Padilla-Sánchez et al 11 assessed heart rates using pulse oximetry during the first 10 min of life after delayed cord clamping. They found an earlier stabilisation of heart rate compared with Dawson et al 3 They attributed this difference to the haemodynamic effects of delayed cord clamping.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, we recorded heart rates by ECG, whereas Dawson et al 3 and Padilla-Sánchez C et al 11 conducted their studies using a pulse oximeter. Pulse oximetry may underestimate heart rates when compared with ECG, especially during the first minutes of life, 4 7 and might have contributed to the lower heart rates and slower rise in heart rate measured by Dawson and Padilla-Sánchez et al We believe that the different methods of measuring heart rates provide an important explanation for the differences between the centiles of Dawson and ours.…”

Section: Original Researchmentioning

confidence: 99%

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Changes in heart rate from 5 s to 5 min after birth in vaginally delivered term newborns with delayed cord clamping

Bjorland

Ersdal

Eilevstjønn

et al. 2020

Arch Dis Child Fetal Neonatal Ed

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ObjectiveTo determine heart rate centiles during the first 5 min after birth in healthy term newborns delivered vaginally with delayed cord clamping.DesignSingle-centre prospective observational study.SettingStavanger University Hospital, Norway, March–August 2019.PatientsTerm newborns delivered vaginally were eligible for inclusion. Newborns delivered by vacuum or forceps or who received any medical intervention were excluded.InterventionsA novel dry electrode electrocardiography monitor (NeoBeat) was applied to the newborn’s chest immediately after birth. The newborns were placed on their mother’s chest or abdomen, dried and stimulated, and cord clamping was delayed for at least 1 min.Main outcome measuresHeart rate was recorded at 1 s intervals, and the 3rd, 10th, 25th, 50th, 75th, 90th and 97th centiles were calculated from 5 s to 5 min after birth.Results898 newborns with a mean (SD) birth weight 3594 (478) g and gestational age 40 (1) weeks were included. The heart rate increased rapidly from median (IQR) 122 (98–146) to 168 (146–185) beats per minute (bpm) during the first 30 s after birth, peaking at 175 (157–189) bpm at 61 s after birth, and thereafter slowly decreasing. The third centile reached 100 bpm at 34 s, suggesting that heart rates <100 bpm during the first minutes after birth are uncommon in healthy newborns after delayed cord clamping.ConclusionThis report presents normal heart rate centiles from 5 s to 5 min after birth in healthy term newborns delivered vaginally with delayed cord clamping.

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Section: Discussionmentioning

confidence: 99%

Section: Original Researchmentioning

confidence: 99%

Changes in heart rate from 5 s to 5 min after birth in vaginally delivered term newborns with delayed cord clamping

Bjorland

Ersdal

Eilevstjønn

et al. 2020

Arch Dis Child Fetal Neonatal Ed

View full text Add to dashboard Cite

show abstract

“…Perhaps this could have been mentioned in the 2020 recommendations? Moreover, the combination of bradycardia (>2 min) and SpO 2 <80% at 5 min is a strong predictor of death and/or severe IVH 17 . Further, delaying cord clamping has changed the reference range for SpO 2 at least in term newborn infants 18 .…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, the combination of bradycardia (>2 min) and SpO 2 <80% at 5 min is a strong predictor of death and/or severe IVH. 17 Further, delaying cord clamping has changed the reference range for SpO 2 at least in term newborn infants. 18 It is likely that, in the near future, values for targeted SpO 2 may need to be modified accordingly.…”

Section: Oxygenationmentioning

confidence: 99%

A critical review of the 2020 International Liaison Committee on Resuscitation treatment recommendations for resuscitating the newly born infant

2021

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The 2020 recommendations from the International Liaison Committee on Resuscitation are an improved version of the 2015 version. The algorithm and 15 procedures are unchanged from 2015, but there are six procedures with new or changed recommendations. One new recommendation is briefing/debriefing following neonatal resuscitation. Procedures with changed suggestions/recommendations are as follows: suctioning of non‐vigorous infants delivered through meconium‐stained amniotic fluid, sustained inflation of preterm infants, optimising epinephrine (adrenaline), vascular access and discontinuing resuscitative efforts. Conclusion In this review, we summarise the present recommendations and offer additional comments and views regarding heart rate detection, cord clamping, oxygenation and thermal control.

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“…In the cohort of Oei et al [33], median time to reach 80% saturation was 6 min for those <29 weeks of GA. Recently, Padilla-Sánchez et al [35] demonstrated a significantly reduced time after birth to reach a target SpO 2 of 80% in vaginally born healthy term infants with delayed cord clamping ≥60 s. Therefore, the time to reach a target SpO 2 of 80% is dependent on several factors in addition to disease severity, such as GA, gender, CPAP or not, and early versus delayed cord clamping, however early bonding did not play a significant role [36]. In some, but not all, studies, mode of delivery played a role with faster increase after vaginal delivery versus cesarean section.…”

Section: Clinical Associations With Spo 2 Developmentmentioning

confidence: 99%

Oxygen in the First Minutes of Life in Very Preterm Infants

2021

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Even a few minutes of exposure to oxygen in the delivery room in very preterm and immature infants may have detrimental effects. The initial oxygenation in the delivery room should therefore be optimized, but knowledge gaps, including initial fraction of oxygen (FiO2) and how FiO2 should be changed to reach an optimal oxygen saturation measured by pulse oximetry (SpO2) target within the first 5–10 min of life, remain. In order to answer this question, we therefore reviewed relevant literature. For newly born infants with gestational age (GA) <32 weeks in need of positive pressure ventilation (PPV) immediately after birth, we identified 2 fundamental issues: (1) the optimal initial FiO2 and (2) the target SpO2 within the first 5–10 min of life. For newly born infants between 29 and 31 weeks of GA, an initial FiO2 of 0.3 hit the target defined by the International Liaison Committee on Resuscitation (ILCOR) best. Newborn infants with GA <29 weeks in need of PPV and supplementary oxygen, we suggest starting with FiO2 0.3 and adjusting the FiO2 to reach SpO2 of 80% within 5 min of life for best outcomes. Prolonged bradycardia (heart rate <100 bpm for >2 min) is associated with increased risk of adverse outcomes, including death. The combination of strict control of development of SpO2 in the first 10 min of life and a heart rate >100 bpm represents the best tool today to achieve the most optimal outcome in the delivery room of very preterm and immature newborn infants.

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Delayed vs Immediate Cord Clamping Changes Oxygen Saturation and Heart Rate Patterns in the First Minutes after Birth

Cited by 49 publications

References 43 publications

Changes in heart rate from 5 s to 5 min after birth in vaginally delivered term newborns with delayed cord clamping

Changes in heart rate from 5 s to 5 min after birth in vaginally delivered term newborns with delayed cord clamping

A critical review of the 2020 International Liaison Committee on Resuscitation treatment recommendations for resuscitating the newly born infant

Oxygen in the First Minutes of Life in Very Preterm Infants

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