Douglas A Blank1, Shiraz Badurdeen2, C Omar F Kamlin3, Susan E Jacobs4, Marta Thio5, Jennifer A Dawson6, Stefan C Kane7, Alicia T Dennis8, Graeme R Polglase9, Stuart B Hooper10, Peter G Davis11. 1. Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia. Electronic address: douglas.blank@thewomens.org.au. 2. Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia. Electronic address: shiraz.badurdeen@thewomens.org.au. 3. Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia. Electronic address: omar.kamlin@thewomens.org.au. 4. Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia. Electronic address: sue.jacobs@thewomens.org.au. 5. Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia. Electronic address: Marta.ThioLluch@thewomens.org.au. 6. Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia. Electronic address: Jennifer.Dawson@thewomens.org.au. 7. The University of Melbourne, Department of Obstetrics and Gynecology, Melbourne, Australia; Pregnancy Research Centre, The Royal Women's Hospital, Melbourne, Australia. Electronic address: Stefan.Kane@thewomens.org.au. 8. The University of Melbourne, Department of Obstetrics and Gynecology, Melbourne, Australia; Department of Anaesthesia, The Royal Women's Hospital, Melbourne, Australia. Electronic address: alicia.dennis@thewomens.org.au. 9. The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia. Electronic address: graeme.polglase@monash.edu. 10. The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia. Electronic address: stuart.hooper@monash.edu. 11. Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia. Electronic address: pgd@unimelb.edu.au.
Abstract
INTRODUCTION: Over five percent of infants born worldwide will need help breathing after birth. Delayed cord clamping (DCC) has become the standard of care for vigorous infants. DCC in non-vigorous infants is uncommon because of logistical difficulties in providing effective resuscitation during DCC. In Baby-Directed Umbilical Cord Clamping (Baby-DUCC), the umbilical cord remains patent until the infant's lungs are exchanging gases. We conducted a feasibility study of the Baby-DUCC technique. METHODS: We obtained antenatal consent from pregnant women to enroll infants born at ≥32 weeks. Vigorous infants received ≥2 min of DCC. If the infant received respiratory support, the umbilical cord was clamped ≥60 s after the colorimetric carbon dioxide detector turned yellow. Maternal uterotonic medication was administered after umbilical cord clamping. A paediatrician and researcher entered the sterile field to provide respiratory support during a cesarean birth. Maternal and infant outcomes in the delivery room and prior to hospital discharge were analysed. RESULTS: Forty-four infants were enrolled, 23 delivered via cesarean section (8 unplanned) and 15 delivered vaginally (6 via instrumentation). Twelve infants were non-vigorous. ECG was the preferred method for recording HR. Two infants had a HR < 100 BPM. All HR values were >100 BPM by 80 s after birth. Median time to umbilical cord clamping was 150 and 138 s in vigorous and non-vigorous infants, respectively. Median maternal blood loss was 300 ml. CONCLUSIONS: It is feasible to provide resuscitation to term and near-term infants during DCC, after both vaginal and cesarean births, clamping the umbilical cord only when the infant is physiologically ready.
INTRODUCTION: Over five percent of infants born worldwide will need help breathing after birth. Delayed cord clamping (DCC) has become the standard of care for vigorous infants. DCC in non-vigorous infants is uncommon because of logistical difficulties in providing effective resuscitation during DCC. In Baby-Directed Umbilical Cord Clamping (Baby-DUCC), the umbilical cord remains patent until the infant's lungs are exchanging gases. We conducted a feasibility study of the Baby-DUCC technique. METHODS: We obtained antenatal consent from pregnant women to enroll infants born at ≥32 weeks. Vigorous infants received ≥2 min of DCC. If the infant received respiratory support, the umbilical cord was clamped ≥60 s after the colorimetric carbon dioxide detector turned yellow. Maternal uterotonic medication was administered after umbilical cord clamping. A paediatrician and researcher entered the sterile field to provide respiratory support during a cesarean birth. Maternal and infant outcomes in the delivery room and prior to hospital discharge were analysed. RESULTS: Forty-four infants were enrolled, 23 delivered via cesarean section (8 unplanned) and 15 delivered vaginally (6 via instrumentation). Twelve infants were non-vigorous. ECG was the preferred method for recording HR. Two infants had a HR < 100 BPM. All HR values were >100 BPM by 80 s after birth. Median time to umbilical cord clamping was 150 and 138 s in vigorous and non-vigorous infants, respectively. Median maternal blood loss was 300 ml. CONCLUSIONS: It is feasible to provide resuscitation to term and near-term infants during DCC, after both vaginal and cesarean births, clamping the umbilical cord only when the infant is physiologically ready.
Authors: Shiraz Badurdeen; Peter G Davis; Stuart B Hooper; Susan Donath; Georgia A Santomartino; Alissa Heng; Diana Zannino; Monsurul Hoq; C Omar F Kamlin; Stefan C Kane; Anthony Woodward; Calum T Roberts; Graeme R Polglase; Douglas A Blank Journal: PLoS Med Date: 2022-06-23 Impact factor: 11.613
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