PDF herunterladen
Am J Perinatol 2024; 41(06): 739-746
DOI: 10.1055/a-1772-4543
Original Article

A Randomized Controlled Trial of a 30- versus a 120-Second Delay in Cord Clamping after Term Birth

Reem M. Soliman
1   Department of Pediatrics, Cairo University, Cairo, Egypt
,
Marwa M. Elgendy 
2   Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
,
Reem N. Said
1   Department of Pediatrics, Cairo University, Cairo, Egypt
,
Bassant I. Shaarawy
1   Department of Pediatrics, Cairo University, Cairo, Egypt
,
Omneya M. Helal
3   Department of Obstetrics and Gynecology, Cairo University Obstetrics and Gynecology Hospital, Cairo, Egypt
,
Hany Aly 
2   Department of Neonatology, Cleveland Clinic Children's Hospital, Cleveland, Ohio
› Institutsangaben Funding This study was registered at www.clinicaltrials.gov (identifier no.: NCT04358822).
› Weitere Informationen
Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Objective Delayed cord clamping (DCC) has been recently adopted in neonatal resuscitation. The immediate cardiac hemodynamic effects related to DCC more than 30 seconds was not studied. We aimed to study the effect of DCC at 120 seconds compared with 30 seconds on multiple hemodynamic variables in full-term infants using an electrical cardiometry (EC) device.

Study Design Present study is a randomized clinical trial. The study was conducted with full-term infants who were delivered at the Obstetrics and Gynecology Department in Cairo University Hospital. Sixty-eight full term infants were successfully enrolled in this trial. Cardiac output (CO) and other hemodynamic parameters were evaluated in this study by EC device. Hemoglobin, glucose, and bilirubin concentrations were measured at 24 hours. Newborn infants were assigned randomly into group 1: DCC at 30 seconds, and group 2: DCC at 120 seconds, based on the time of cord clamping.

Results Stroke volume (SV) (mL) and CO (L/min) were significantly higher in group 2 compared with group 1 at 5 minutes (6.71 vs. 5.35 and 1.09 vs. 0.75), 10 minutes (6.43 vs. 5.59 and 0.88 vs. 0.77), 15 minutes (6.45 vs. 5.60 and 0.89 vs. 0.76), and 24 hours (6.67 vs. 5.75 and 0.91vs. 0.81), respectively. Index of contractility (ICON; units) was significantly increased in group 2 at 5 minutes compared with group1 (114.2 vs. 83.8). Hematocrit (%) and total bilirubin concentrations (mg/dL) at 24 hours were significantly increased in group 2 compared with group 1 (51.5 vs. 40.5 and 3.8 vs. 2.9, respectively).

Conclusion Stroke volume and cardiac output are significantly higher in neonates with DCC at 120 seconds compared with 30 seconds that continues for the first 24 hours.

Key Points

  • CO is significantly increased with DCC at 120 seconds.

  • SV is significantly increased with DCC at 120 seconds.

  • Such effects continued during the entire 24 hours of life in full-term infants.

Keywords

cord clamping - heart rate - full-term infants - cardiac output - contractility

Authors' Contribution

R.M.S. and M.M.E. conceptualized and designed the study, interpreted the statistical analyses, drafted the initial manuscript, reviewed, and revised the manuscript; coordinated and supervised data collection; and critically reviewed the manuscript for important intellectual content. R.N.S., B.I.S., and O.M.H. interpreted the statistical analyses, drafted the initial manuscript, reviewed, and revised the manuscript; coordinated and supervised data collection; and critically reviewed the manuscript for important intellectual content. H.A. conceptualized and designed the study, performed the initial analyses, and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.


Supplementary Material



Publikationsverlauf

Eingereicht: 05. Dezember 2021

Angenommen: 09. Februar 2022

Accepted Manuscript online:
15. Februar 2022

Artikel online veröffentlicht:
11. März 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Ultee CA, van der Deure J, Swart J. et al. Delayed cord clamping in preterm infants delivered at 34-36 weeks' gestation: a randomized controlled trial. Arch Dis Child Fetal Neonatal Ed 2008; 93 (01) 20-23
    CrossrefPubMedSuche in Google Scholar
  • 2 Oh W, Fanaroff AA, Carlo WA, Donovan EF, McDonald SA, Poole WK. Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Effects of delayed cord clamping in very-low-birth-weight infants. J Perinatol 2011; 31 (1, suppl 1): S68-S71
    CrossrefPubMedSuche in Google Scholar
  • 3 van Vonderen JJ, Roest AA, Siew ML, Walther FJ, Hooper SB, te Pas AB. Measuring physiological changes during the transition to life after birth. Neonatology 2014; 105 (03) 230-242
    CrossrefPubMedSuche in Google Scholar
  • 4 Katheria AC, Leone TA, Woelkers D, Garey DM, Rich W, Finer NN. The effects of umbilical cord milking on hemodynamics and neonatal outcomes in premature neonates. J Pediatr 2014; 164 (05) 1045-1050 .e1
    CrossrefPubMedSuche in Google Scholar
  • 5 Winter J, Kattwinkel J, Chisholm C, Blackman A, Wilson S, Fairchild K. Ventilation of preterm infants during delayed cord clamping: a pilot study of feasibility and safety. Am J Perinatol 2017; 34 (02) 111-116
    Thieme ConnectPubMedSuche in Google Scholar
  • 6 Bhatt S, Alison BJ, Wallace EM. et al. Delaying cord clamping until ventilation onset improves cardiovascular function at birth in preterm lambs. J Physiol 2013; 591 (08) 2113-2126
    CrossrefPubMedSuche in Google Scholar
  • 7 Hooper SB, Te Pas AB, Lang J. et al. Cardiovascular transition at birth: a physiological sequence. Pediatr Res 2015; 77 (05) 608-614
    CrossrefPubMedSuche in Google Scholar
  • 8 Armanian AM, Ghasemi Tehrani H. et al. Is delayed umbilical cord clamping beneficial for premature newborns?. Int J Pediatr 2017; 5 (05) 4909-4918
    PubMedSuche in Google Scholar
  • 9 Committee Opinion no. 684: delayed umbilical cord clamping after birth. Obstet Gynecol 2017; 129 (01) 1
    CrossrefPubMedSuche in Google Scholar
  • 10 Katheria AC, Brown MK, Faksh A. et al. Delayed cord clamping in newborns born at term at risk for resuscitation: a feasibility randomized clinical trial. J Pediatr 2017; 187: 313-317 .e1
    CrossrefPubMedSuche in Google Scholar
  • 11 Chiruvolu A, Elliott E, Rich D, Stone GL, Qin H, Inzer RW. Effect of delay in cord clamping 45 versus 60 s on very preterm singleton infants. Early Hum Dev 2018; 119: 15-18
    CrossrefPubMedSuche in Google Scholar
  • 12 van Vonderen JJ, Roest AA, Siew ML. et al. Noninvasive measurements of hemodynamic transition directly after birth. Pediatr Res 2014; 75 (03) 448-452
    CrossrefPubMedSuche in Google Scholar
  • 13 Dawson JA, Davis PG, O'Donnell CP, Kamlin CO, Morley CJ. Pulse oximetry for monitoring infants in the delivery room: a review. Arch Dis Child Fetal Neonatal Ed 2007; 92 (01) F4-F7
    CrossrefPubMedSuche in Google Scholar
  • 14 Noori S, Drabu B, Soleymani S, Seri I. Continuous non-invasive cardiac output measurements in the neonate by electrical velocimetry: a comparison with echocardiography. Arch Dis Child Fetal Neonatal Ed 2012; 97 (05) F340-F343
    CrossrefPubMedSuche in Google Scholar
  • 15 Hsu K-H, Wu T-W, Wang Y-C, Lim WH, Lee CC, Lien R. Hemodynamic reference for neonates of different age and weight: a pilot study with electrical cardiometry. J Perinatol 2016; 36 (06) 481-485
    CrossrefPubMedSuche in Google Scholar
  • 16 Suresh K. An overview of randomization techniques: an unbiased assessment of outcome in clinical research. J Hum Reprod Sci 2011; 4 (01) 8-11
    CrossrefPubMedSuche in Google Scholar
  • 17 Katheria AC, Truong G, Cousins L, Oshiro B, Finer NN. Umbilical cord milking versus delayed cord clamping in preterm infants. Pediatrics 2015; 136 (01) 61-69
    CrossrefPubMedSuche in Google Scholar
  • 18 Weisz DE, Jain A, McNamara PJ, EL-Khuffash A. Non-invasive cardiac output monitoring in neonates using bioreactance: a comparison with echocardiography. Neonatology 2012; 102 (01) 61-67
    CrossrefPubMedSuche in Google Scholar
  • 19 Lang JA, Pearson JT, Binder-Heschl C. et al. Increase in pulmonary blood flow at birth: role of oxygen and lung aeration. J Physiol 2016; 594 (05) 1389-1398
    CrossrefPubMedSuche in Google Scholar
  • 20 Rabe H, Diaz-Rossello JL, Duley L, Dowswell T. Effect of timing of umbilical cord clamping and other strategies to influence placental transfusion at preterm birth on maternal and infant outcomes. Cochrane Database Syst Rev 2012; 8 (08) CD003248
    PubMedSuche in Google Scholar
  • 21 Mercer JS, Erickson-Owens DA. Rethinking placental transfusion and cord clamping issues. J Perinat Neonatal Nurs 2012; 26 (03) 202-217 , quiz 218–219
    CrossrefPubMedSuche in Google Scholar
  • 22 Rowland DG, Gutgesell HP. Noninvasive assessment of myocardial contractility, preload, and afterload in healthy newborn infants. Am J Cardiol 1995; 75 (12) 818-821
    CrossrefPubMedSuche in Google Scholar
  • 23 Reuter DA, Felbinger TW, Schmidt C. et al. Stroke volume variations for assessment of cardiac responsiveness to volume loading in mechanically ventilated patients after cardiac surgery. Intensive Care Med 2002; 28 (04) 392-398
    CrossrefPubMedSuche in Google Scholar
  • 24 Katheria A, Poeltler D, Durham J. et al. Neonatal resuscitation with an intact Cord: A randomized clinical trial. J Pediatr 2016; 178: 75-80 .e3
    CrossrefPubMedSuche in Google Scholar
  • 25 Katheria AC, Wozniak M, Harari D, Arnell K, Petruzzelli D, Finer NN. Measuring cardiac changes using electrical impedance during delayed cord clamping: a feasibility trial. Matern Health Neonatol Perinatol 2015; 1 (01) 15
    CrossrefPubMedSuche in Google Scholar