Physiological-based cord clamping in preterm infants using a new purpose-built resuscitation table: a feasibility study

• Published in: Archives of disease in childhood. Fetal and neonatal edition Vol. 104; no. 4; pp. F396 - F402
• Main Authors: Brouwer, Emma, Knol, Ronny, Vernooij, Alex S N, van den Akker, Thomas, Vlasman, Patricia E, Klumper, Frans J C M, DeKoninck, Philip, Polglase, Graeme R, Hooper, Stuart B, te Pas, Arjan B
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.07.2019; BMJ Publishing Group
• Subjects: Babies; Blood; Continuous positive airway pressure; Feasibility studies; Heart rate; Infants; Newborn babies; Observational studies; Obstetrics; Original; Oxygen; Oxygenation; Pediatrics; Physiology; Premature babies; Premature birth; Umbilical cord; Ventilators; Netherlands; Germany; physiology; resuscitation; neonatology; respiratory; circulatory
• ISSN: 1359-2998; 1468-2052
• DOI: 10.1136/archdischild-2018-315483

ObjectivePhysiological-based cord clamping (PBCC) led to a more stable cardiovascular adaptation and better oxygenation in preterm lambs, but in preterm infants, this approach has been challenging. Our aim was to assess the feasibility of PBCC, including patterns of oxygen saturation (SpO2) and heart rate (HR) during stabilisation in preterm infants using a new purpose-built resuscitation table.DesignObservational study.SettingTertiary referral centre, Leiden University Medical Centre, The Netherlands.PatientsInfants born below 35 weeks’ gestational age.InterventionsInfants were stabilised on a new purpose-built resuscitation table (Concord), provided with standard equipment needed for stabilisation. Cord clamping was performed when the infant was stable (HR >100 bpm, spontaneous breathing on continuous positive airway pressure with tidal volumes >4 mL/kg, SpO2 ≥25th percentile and fraction of inspired oxygen (FiO2) <0.4).ResultsThirty-seven preterm infants were included; mean (SD) gestational age of 30.9 (2.4) weeks, birth weight 1580 (519) g. PBCC was successful in 33 infants (89.2%) and resulted in median (IQR) cord clamping time of 4:23 (3:00–5:11) min after birth. There were no maternal or neonatal adverse events. In 26/37 infants, measurements were adequate for analysis. HR was 113 (81–143) and 144 (129–155) bpm at 1 min and 5 min after birth. SpO2 levels were 58%(49%–60%) and 91%(80%–96%)%), while median FiO2 given was 0.30 (0.30–0.31) and 0.31 (0.25–0.97), respectively.ConclusionPBCC in preterm infants using the Concord is feasible. HR remained stable, and SpO2 quickly increased with low levels of oxygen supply.Trial registration numberNTR6095, results.