Measuring cardiac changes using electrical impedance during delayed cord clamping: a feasibility trial

Abstract

BackgroundTo date no study has attempted to continuously evaluate changes in hemodynamics during delayed cord clamping in humans. We aimed to demonstrate 1. the feasibility of measurements of hemodynamics during delayed cord clamping and 2. to describe the changes that occur over each minute.ResultsAfter vaginal delivery, term infants (370-416 weeks) were placed on a Life Start® bed 10–20 cm below the placenta. Transcutaneous sensors were placed on the neck and chest to determine heart rate, stroke volume and cardiac output at each beat. Once a signal was obtained, first 5 values (taken every beat) were averaged and the percent change for each subject from baseline was calculated. 20 infants were enrolled and all had a reliable signal obtained from transcutaneous sensors and had a delay in cord clamping for about 5 minutes. Cardiac output increased from 2 to 5 minutes of life (p = 0.008). For every minute of life the cord was kept unclamped, the stroke volume increased 13.1% ± 12.3 (p = 0.0001) and cardiac output increased 12.6% ± 6.3 from baseline (p < 0.0001). While the majority of infants continued to have an increase in cardiac output at 5 minutes of life, 7/20 infants reached their peak cardiac output at 188 ± 41 seconds of life.ConclusionsThis study demonstrates that hemodynamic measures could be successfully obtained during the first five minutes of birth and while a newborn was receiving delayed cord clamping. This study also provides reference values for changes in cardiac output and stroke volume in well term infants during delayed cord clamping.Trial registrationClinical Trials.gov NCT02195037 Registered 17 July 2014

Providing a Placental Transfusion in Newborns Who Need Resuscitation

“…In a study of 20 healthy term newborns with 5 min of DCC, an improvement in stroke volume and cardiac output was demonstrated over the first 5 min of life. The mean time to cord pulsation cessation was 199 ± 76 s but cardiovascular benefits extended beyond the time of cessation (49). The term infant with shoulder dystocia whose umbilical cord is constricted as the neonate is squeezed in the birth canal is likely to have a portion of his blood shunted to the placenta (50, 51).…”

Haemodynamic Transition after Birth: A New Tool for Non-Invasive Cardiac Output Monitoring

“…Weisz et al [6] demonstrated in 10 neonates that NICOM can detect LVO, but they also concluded that EV cannot replace echocardiography, especially to determine the physiologic or anatomic nature of changes in LVO. Recently, Katheria et al [15] published data on CO using a similar EV device in 20 term newborns. But their infants were (1) born vaginally and (2) had delayed cord clamping, i.e.…”

Geciktirilmiş Umbilikal Kordon Klemplemenin Yenidoğan Sağlığına Etkisi

“…GKK ile sağlanan plasental transfüzyonun doğumdan sonra kalbin ön yükünü artırdığı, akciğerin vasküler sisteminde gelişen değişiklikler ile birlikte pulmoner kan akımını artırarak yeterli sol ventrikül debisinin sağlanmasına yardımcı olduğu ve buna bağlı olarak kardiyak outputu artırarak hipoksiyi önlediği bildirilmektedir (4,32,33). Term yenidoğanlar ile yapılan bir çalışmada; transkütan sensörler aracılığıyla kalp hızı, stroke volüm ve kardiyak output doğumdan sonra 2-5 dakika boyunca ölçülmüş ve bazal değerine göre 5. dakikada stroke volüm %13,1 (±12,3), kardiyak outputun %13,1 (±12,3) daha fazla olduğu tespit edilmiştir (34) (36). Bir çalışmada doğum şekli kontrol edildikten sonra (sezaryen ve vaginal doğum) EKK ve GKK gruplarında primer maternal güvenlik ölçümlerinde (beklenen maternal kan kaybı, hematokrit değerindeki düşüş) fark bulunmamıştır (37).…”