Umbilical Cord Management in Late Preterm and Term Infants: A Randomized Controlled Trial

Kılıçdağ, Hasan; Karagun, Barbaros Sahin; Antmen, Ali Bülent; Candan, Erdal; Erbas, Hale

doi:10.1055/s-0040-1722327

Cited by 11 publications

(11 citation statements)

References 37 publications

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“…In our study, I-UCM and DCC for term neonates resulted in similar Hb and Hct outcomes, but further controlled trials are required for a full assessment. In our previous study, when comparing I-UCM to C-UCM with immediate cord clamping in neonates delivered >35 weeks' gestation, I-UCM was found to be the better option ( 41 ).…”

Section: Discussionmentioning

confidence: 99%

Effects of spontaneous first breath on placental transfusion in term neonates born by cesarean section: A randomized controlled trial

et al. 2022

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BackgroundThe role of umbilical cord management in placental transfusion in cesarean section (CS) requires clarification. The spontaneous first breath may be more important than the timing of cord clamping for placental transfusion in neonates born by CS.ObjectiveThis study aimed to evaluate the impact of cord clamping after the first spontaneous breath on placental transfusion in neonates born by CS.MethodsWe recruited women with a live singleton pregnancy at ≥37.0 weeks of gestation admitted for CS. The interventions performed, such as physiologic-based cord clamping (PBCC), intact-umbilical cord milking (I-UCM), 30-s delay in cord clamping (30-s DCC), and 60-s delay in cord clamping (60-s DCC), were noted and placed in a sealed envelope. The sealed envelope was opened immediately before delivery to perform randomization.ResultsA total of 123 infants were eligible for evaluation. Of these, 31, 30, 32, and 30 were assigned to the PBCC, I-UCM, 30-s DCC, and 60-s DCC groups, respectively. The mean hemoglobin (Hb) and mean hematocrit (Hct) were significantly higher in the 60-s DCC group than in the PBCC group (p = 0.028 and 0.019, respectively), but no difference was noted among the I-UCM, 30-s DCC, and PBCC groups at 36 h of age. Further, no significant differences were observed in the mean Hb and mean Hct among the I-UCM, 60-s DCC, and 30-s DCC groups. Peak total serum bilirubin (TSB) levels were higher in the 60-s DCC group than in the I-UCM and PBCC groups (p = 0.017), but there was no difference between the 60-s DCC and 30-s DCC groups during the first week of life. The phototherapy requirement was higher in 60-s DCC than in IUCM and 30-sDCC (p = 0.001).ConclusionsOur findings demonstrated that PBCC, 30-s DCC, and I-UCM in neonates born by CS had no significant differences from each other on placental transfusion. The Hb and Hct in the neonates were higher after 60-s DCC than after PBCC.

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Section: Discussionmentioning

confidence: 99%

Effects of spontaneous first breath on placental transfusion in term neonates born by cesarean section: A randomized controlled trial

et al. 2022

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“…Also was found comparisons between the types of milking C-UCM and I-UCM (29,43,57,78) . Other studies performed other types of comparison, such as: UCM x 'non-milking' (34,40) , ICC x DCC x UCM (71) and UCM x DCC x DCC with UCM (25,79) .…”

Section: Resultsmentioning

confidence: 99%

“…A study compare UCM x 'nonmilking', demonstrated benefits in the neurological development of newborns submitted to milking (34,40) . Others that compared ICC x DCC x UCM, finding higher levels of hemoglobin and hematocrit in the last two groups (71) , and greater oxidative stress (13) , higher mortality or major morbidity (56) , lower 5-minute Apgar's score in those submitted to ICC. Also was identified that there were no significant differences between groups for measures of electroencephalogram activity or cerebral near infrared spectroscopy (52) , total oxidant capacity, oxidative stress index, and peroxynitrite measurements (81) .…”

Section: Discussionmentioning

confidence: 99%

Umbilical Cord Milking in Newborns: Scoping Review

ALVES¹,

FREITAS²,

GAÍVA³

2022

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Objective: To map the available evidence on umbilical cord milking in newborns. Material and Method: Scoping Review based on the protocol proposed by the Joanna Briggs Institute. A search for full-text articles published in MEDLINE, SCOPUS, WOS and CINAHL was carried out using the following keywords: infant, newborn, umbilical cord milking, placental transfusion and umbilical cord blood. Results: The results indicated umbilical cord milking has superior benefits to the immediate cord clamping, among the main ones are higher levels of Hemoglobin, Hematocrit and Serum Ferritin, and reduction of complications in preterm newborns, such as intraventricular hemorrhage and the need for blood transfusion. When compared to delayed cord clamping, it has similar benefits, but milking is considered a faster method of placental blood transfusion. Conclusions: Umbilical cord milking has similar potential to delayed cord clamping. Therefore, it can be an alternative for obstetric nurses and midwives when delayed cord clamping cannot be performed in order to ensure the benefits of placental transfusion to the neonate.

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“…Whether different techniques of placental transfusion have similar effect on hemoglobin (Hb) level is point of debate in various studies. Kilicdag and Shirk showed no significant differences regarding Hb level between C-UCM and I-UCM, and DCC and I-UCM, respectively [ 18 , 19 ]. Katheria et al showed significant difference in Hb levels between DCC and I-UCM in preterm infants born by C-section, in which infants in DCC group are expected to have lower Hb levels owing to lack of effective uterine contractions in their mothers [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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Despite of growing evidence of the beneficial effects of placental transfusion techniques, there is no available sufficient data about their effects on vulnerable hemodynamics and myocardium of premature infants. The purpose of this work is to study ventricular functions and hemodynamics after applying different placental transfusion techniques, delayed cord clamping (DCC), cut cord milking (C-UCM), and intact cord milking (I-UCM). Sixty-four infants delivered whether by C-section or vaginal delivery were randomly assigned to undergo C-UCM (20–30 cm), I-UCM (3–4 strippings), and DCC (30–60 s). Functional echocardiography was done on day 1 and day 3 of life for 57 infants. Primary outcome variable was superior vena cava flow measurement in infants having placental transfusion in the first 24 h of life and between 64 and 72 h. Secondary outcomes were other echocardiographic and clinical hemodynamic parameters, and biventricular functions in those infants. Of a total 196 preterm infants ≤ 32 weeks delivered in the study period, from January 2021 to August 2021, 57 infants were eligible and survived till the second examination. They were randomly assigned to the three groups. Neonates randomly assigned to DCC had significantly higher superior vena cava flow and lower right ventricular systolic function in the first 24 h of life. This finding vanished at day 3. Neonates undergone different methods of placental transfusions had similar hemoglobin, admission temperature, and mean blood pressure in the first 24 h of life.Conclusion: Despite their potential benefits, placental transfusions have shown to alter the hemodynamics and adversely affect myocardial function of premature neonates.Trial registration: This trial was registered in the clinical trial gov NCT04811872. What is Known:• Placental transfusion techniques might have benefits regarding prematurity- related morbidities and mortality. What is New:• Placental transfusion might adversely affect the myocardium and alter hemodynamics in premature infants.

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Umbilical Cord Management in Late Preterm and Term Infants: A Randomized Controlled Trial

Cited by 11 publications

References 37 publications

Effects of spontaneous first breath on placental transfusion in term neonates born by cesarean section: A randomized controlled trial

Effects of spontaneous first breath on placental transfusion in term neonates born by cesarean section: A randomized controlled trial

Umbilical Cord Milking in Newborns: Scoping Review

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

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