Himanshu Popat1,2, Claire Galea3,4, Nicholas Evans3,5, Barbara Lingwood6, Paul B Colditz6, Robert Halliday7,3, David Osborn3,5. 1. The Children's Hospital at Westmead, Westmead, New South Wales, Australiahimanshu.popat@health.nsw.gov.au. 2. University of Sydney, Camperdown, New South Wales, Australiahimanshu.popat@health.nsw.gov.au. 3. University of Sydney, Camperdown, New South Wales, Australia. 4. Cerebral Palsy Research Alliance Institute, Sydney, New South Wales, Australia. 5. Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia. 6. UQ Centre for Clinical Research, The University of Queensland and Royal Brisbane and Women's Hospital, Brisbane City, Queensland, Australia. 7. The Children's Hospital at Westmead, Westmead, New South Wales, Australia.
Abstract
BACKGROUND AND OBJECTIVE: The mechanism of reported benefits of delayed cord clamping (DCC) are unclear. We aimed to determine whether DCC compared to immediate cord clamping (ICC) in very preterm infants improves cerebral oxygenation in the first 24 h. STUDY DESIGN: This is a prospective study of a subset of infants at < 30 weeks of gestation who were randomised toDCC (≥60 s) or ICC (< 10 s) and required an indwelling arterial catheter. Regional cerebral oxygenation (rScO2), blood pressure, PI, and peripheral saturation were measured and cerebral fractional tissue oxygen extraction (cFTOE) calculated for the following 3 time intervals: 3-6, 6-12, and 12-28 h of age. Functional ultrasound measures including superior vena cava flow, right ventricular output, ductus arteriosus size and shunt and anterior cerebral artery resistive index were determined. RESULTS: The mean (±SD) gestation and birth weight of the 51 study infants were 27 ± 1 weeks and 1,046 ± 241 g respectively. Twenty infants received DCC and 31 received ICC. Baseline demographics were similar between the 2 groups. Comparing DCC and ICC infants, there was no difference in rScO2 or cFTOE at any time point. Three out of 20 infants did not receive DCC due to clinical concerns. A sensitivity analysis revealed that cord clamping ≥30 s was significantly associated with increased rScO2 and decreased cFTOE at all 3 time points after adjusting for gestation. CONCLUSION: Although DCC was not associated with changes in cerebral oxygenation overall, sensitivity analysis suggested a possible effect of an increased rScO2 and a decreased cFTOE with ≥30 s of DCC.
RCT Entities:
BACKGROUND AND OBJECTIVE: The mechanism of reported benefits of delayed cord clamping (DCC) are unclear. We aimed to determine whether DCC compared to immediate cord clamping (ICC) in very preterm infants improves cerebral oxygenation in the first 24 h. STUDY DESIGN: This is a prospective study of a subset of infants at < 30 weeks of gestation who were randomised to DCC (≥60 s) or ICC (< 10 s) and required an indwelling arterial catheter. Regional cerebral oxygenation (rScO2), blood pressure, PI, and peripheral saturation were measured and cerebral fractional tissue oxygen extraction (cFTOE) calculated for the following 3 time intervals: 3-6, 6-12, and 12-28 h of age. Functional ultrasound measures including superior vena cava flow, right ventricular output, ductus arteriosus size and shunt and anterior cerebral artery resistive index were determined. RESULTS: The mean (±SD) gestation and birth weight of the 51 study infants were 27 ± 1 weeks and 1,046 ± 241 g respectively. Twenty infants received DCC and 31 received ICC. Baseline demographics were similar between the 2 groups. Comparing DCC and ICC infants, there was no difference in rScO2 or cFTOE at any time point. Three out of 20 infants did not receive DCC due to clinical concerns. A sensitivity analysis revealed that cord clamping ≥30 s was significantly associated with increased rScO2 and decreased cFTOE at all 3 time points after adjusting for gestation. CONCLUSION: Although DCC was not associated with changes in cerebral oxygenation overall, sensitivity analysis suggested a possible effect of an increased rScO2 and a decreased cFTOE with ≥30 s of DCC.
Authors: Tanja van Essen; Tom G Goos; Liza van Ballegooijen; Gerhard Pichler; Berndt Urlesberger; Irwin K M Reiss; Rogier C J de Jonge Journal: BMC Pediatr Date: 2020-02-28 Impact factor: 2.125