Laura Marrs1, Susan Niermeyer2. 1. University of Colorado School of Medicine. 2. University of Colorado School of Medicine, Colorado School of Public Health, Aurora, Colorado, USA.
Abstract
PURPOSE OF REVIEW: For over a decade, the International Liaison Committee on Resuscitation has recommended delayed cord clamping (DCC), but implementation has been variable due to lack of consensus on details of technique and concerns for risks in certain patient populations. This review summarizes recent literature on the benefits and risks of DCC in term and preterm infants and examines alternative approaches such as physiologic-based cord clamping or intact cord resuscitation (ICR) and umbilical cord milking (UCM). RECENT FINDINGS: DCC improves hemoglobin/hematocrit among term infants and may promote improved neurodevelopment. In preterms, DCC improves survival compared to early cord clamping; however, UCM has been associated with severe intraventricular hemorrhage in extremely preterm infants. Infants of COVID-19 positive mothers, growth-restricted babies, multiples, and some infants with cardiopulmonary anomalies can also benefit from DCC. Large randomized trials of ICR will clarify safety and benefits in nonvigorous neonates. These have the potential to dramatically change the sequence of events during neonatal resuscitation. SUMMARY: Umbilical cord management has moved beyond simple time-based comparisons to nuances of technique and application in vulnerable sub-populations. Ongoing research highlights the importance of an individualized approach that recognizes the physiologic equilibrium when ventilation is established before cord clamping.
PURPOSE OF REVIEW: For over a decade, the International Liaison Committee on Resuscitation has recommended delayed cord clamping (DCC), but implementation has been variable due to lack of consensus on details of technique and concerns for risks in certain patient populations. This review summarizes recent literature on the benefits and risks of DCC in term and preterm infants and examines alternative approaches such as physiologic-based cord clamping or intact cord resuscitation (ICR) and umbilical cord milking (UCM). RECENT FINDINGS: DCC improves hemoglobin/hematocrit among term infants and may promote improved neurodevelopment. In preterms, DCC improves survival compared to early cord clamping; however, UCM has been associated with severe intraventricular hemorrhage in extremely preterm infants. Infants of COVID-19 positive mothers, growth-restricted babies, multiples, and some infants with cardiopulmonary anomalies can also benefit from DCC. Large randomized trials of ICR will clarify safety and benefits in nonvigorous neonates. These have the potential to dramatically change the sequence of events during neonatal resuscitation. SUMMARY: Umbilical cord management has moved beyond simple time-based comparisons to nuances of technique and application in vulnerable sub-populations. Ongoing research highlights the importance of an individualized approach that recognizes the physiologic equilibrium when ventilation is established before cord clamping.
Authors: Judith S Mercer; Debra A Erickson-Owens; Sean C L Deoni; Douglas C Dean Iii; Richard Tucker; Ashley B Parker; Sarah Joelson; Emily N Mercer; Jennifer Collins; James F Padbury Journal: Am J Perinatol Date: 2020-07-21 Impact factor: 1.862
Authors: Beth Ellen Brown; Prakesh S Shah; Jehier K Afifi; Rebecca L Sherlock; Mohammad A Adie; Luis A Monterrosa; Joan M Crane; Xiang Y Ye; Walid I El-Naggar Journal: Am J Obstet Gynecol Date: 2021-08-09 Impact factor: 8.661
Authors: Judith S Mercer; Debra A Erickson-Owens; Sean C L Deoni; Douglas C Dean; Jennifer Collins; Ashley B Parker; Meijia Wang; Sarah Joelson; Emily N Mercer; James F Padbury Journal: J Pediatr Date: 2018-07-06 Impact factor: 6.314
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