Umbilical Cord Clamping Timing in Preterm Infants Delivered by Cesarean Section

Authors

1 Professor of Pediatrics and Neonatology, Womens' Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

2 Neonatologist, Tabriz University of Medical Sciences, Tabriz, Iran.

3 Professor of Obstetrics and Gynecology, Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

Abstract

Background: The timing of umbilical cord clamping may affect the need to bloodtransfusion and other morbidities of preterm infants. This study aimed to compare three different cord clamping timing (immediate cord clamping, delayed cord clamping and umbilical cord milking) in preterm infants delivered by cesarean section (CS).
Materials and Methods
A controlled randomized clinical trial was done in preterm infants with gestation age less than 32 weeks delivered by CS in AlZahra hospital, Tabriz, Iran from June 2018 up to the end of January 2019. They were randomly allocated in three groups consisted of 30 neonates in each group. Umbilical cord was clamped within 10 seconds after infant delivery in immediate cord clamping (ICC) group, 60 seconds after delivery in delayed cord clamping (DCC) group. Cord was milked toward the infant three times over two seconds duration in umbilical cord milking (UCM) group. All patients were followed until discharge for needing the blood transfusion, bronchopulmonary dysplasia and mortality.
Results: A total of 20 neonates of 90 studied neonates needed blood transfusion during hospital stay, of which,  4 neonates (13.3%) were  in UCM group,  7 neonates (23.3%) in DCC group and 9 patients (30%) in ICC group (P= 0.27). The mean hemoglobin was significantly higher in UCM group at admission and 30 days after birth (P<0.05).
Conclusion
UCM may be as effective as DCC to increase hemoglobin in preterm infants delivered by CS. Although the hemoglobin of infants with DCC and UCM was significantly higher than infants with ICC, the rate of blood transfusion was not significantly decreased during hospital stay.

Keywords

References

1- March MI, Hacker MR, Parson AW, Modest AM, de Vecino M. The effects of umbilical cord milking inextermely preterm infants: A randomized controlled trial. J Perinatol 2013; 33: 763-67.
2- Strauss RG, Moch DM, Johnson KJ, Cress GA, Burmeistewr LF, Zimneman MB, et al. A randomized clinical trial comparing immediate versus delayed claming of umbilical cord in preterm infants: short term clinical and laboratory endpoints.Transfusion 2008; 48: 658-65.
3- Committee on Obstetric practice committee opinion No. 684: delayed umbilical cord clamping after birth. ObstetGynecol 2017; 129:e5-10.
4- Moradi WT, Morris J, Kiby A, Robledo K, Askie L, Brown R, et al. delayed cord clamping in preterm infants. The New Engl J Med. 2012; 377:2445-55.
5- Rabe H, Reynolds G, Diaz-Rossello JL. A systematic review and meta-analysis of a brief delay in clamping of umbilical cord of preterm infants. Neonatology 2008; 93:138-44.
6- Manley BJ, Owen LS, Hooper SB, Jacobs SE, Cheong JLY, Doyle LW, et al. Towards evidence based resuscitation of newborn infants. Lancet 2017; 389: 1639-48.
7- Robe H, Reynolds G, Draz- Rossello J. A systematic review and meta-analysis of a brief delay in clamping the umbilical cord of preterm infants. Neonatology 2008; 93: 138-44.
8- Al-Wassian H, Shah PS. Efficacy and safety of cord milking at birth: a systematic review and meta- analysis. JAMA Pediatr 2015; 169 (1):18-25.
9- Aladangady N, Mc Hugh S, Aitchinsov TC, Wardrop CA, Holland BM. Infants blood volume in a controlled trial of placental transfusion at preterm delivery. Pediatr 2008; 117 (1):93-98.
10- Struss RG, Mock DM, Johnson K,  Mock NI, Cress G, Knosp L, et al. circulating RBC volume measured with biotinylated RBCs is superior to the hematocrit to document the hematologic effect of delayed versus immediate umbilical cord clamping in preterm neonates. Transfusion 2003: 43 (8): 1168-1172.
11- McDonnel M, Henderson-Smat DJ.Delayed umbilical cord clamping in preterm infants: A feasibility study. J Pediatr Child Health 1997; 33 (4): 308-10.
12- Fogarty M, Osborn DA, Askie L, Seider AL, Hunter K, Lui K, et al. delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol 2018. Doi 10.1016/j.ajog. 2017.10.231.
13- Rabe H, Diaz- Rosello JL, Duley L, Dowsewell T. Effect of timing umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 2012; 15 (8): CD003248. doi: 10.1002/14651858.CD003248.pub3.
14-katheria AC, Truong G, Cousins L, Oshiro B, Finer NN.Umbilical cord versus delayed cord clamping in preterm infants. Pediatrics 2015; 136 (1): 61-9.
15- kumar B, Upadhyay A, Gothwal S, Jaiswal V, Joshi P, Dubey K. Umbilical  cord milking and hematological parameters in moderate to late preterm neonates: a randomized controlled trial. IndianPediatr 2015; 52: 753-57.
16-  Alsafadi TRM,  Hashmi SM,  Youssef HA, SulimanAK,  Mansour Abbas H,  Albaloushi MH . J Clin Neonatol. 2014; 3 (2): 93–98.
17-Jobe AH, Bancalari E. Bronchopulmonary dysplasia. Am J Resp Crit Care. 2001. 163: 1723-29.
18- Weiner G M, Zaichkin J, American Academy of Pediatrics and American Heart Association.
Textbook of Neonatal Resuscitation (NRP), 7th Ed. 2016.
19-Tarnow-Mordi W, Morris J, Kirby A, et al. Delayed versus immediate cord clamping in preterm infants. N Engl J Med 2017; 377:2445-55.
20- Gokalp AS,  Gunlemez A,  Oguz D. Umbilical Cord Clamping Time in Premature Infants. J Neonatal Biol 2017, 6:1.DOI:10.4172/2167-0897.1000248
21- Colm P.F. O’Donnell, M.B., B.Ch. The Timing of Cord Clamping for Preterm Infants N Engl J Med. 2017; 377;25 :2488-2489.
22- Prockop DJ, Oh JY. Mesenchymal stem/stromal cells: roles as guardians of inflammation. Mol Ther 2012; 20: 14-20.
Journal of Pediatric Perspectives
Volume 8, Issue 4 - Serial Number 76
April 2020
Pages 11095-11101

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