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Placental blood transfusion can be achieved by delayed cord clamping and umbilical cord milking.The World Health Organization has proposed delayed cord clamping as the standard care for newborns that do not require resuscitation.In recent years, umbilical cord milking has become an alternative to delayed cord clamping due to the short duration, quick recovery of the fetus after delivery, and similar effect on placental blood transfusion to that of the delayed cord clamping.This study aims to summarize the research results of the two intervention methods, and their potential benefits and risks, aiming to provide references for the optimal umbilical cord cutting.
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OBJECTIVES@#To study the influence of umbilical cord milking versus delayed cord clamping on the early prognosis of preterm infants with a gestational age of <34 weeks.@*METHODS@#PubMed, Web of Science, Embase, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wanfang Data, Weipu Database, and SinoMed were searched for randomized controlled trials on umbilical cord milking versus delayed cord clamping in preterm infants with a gestational age of <34 weeks published up to November 2021. According to the inclusion and exclusion criteria, two researchers independently performed literature screening, quality evaluation, and data extraction. Review Manger 5.4 was used for Meta analysis.@*RESULTS@#A total of 11 articles were included in the analysis, with 1 621 preterm infants in total, among whom there were 809 infants in the umbilical cord milking group and 812 in the delayed cord clamping group. The Meta analysis showed that compared with delayed cord clamping, umbilical cord milking increased the mean blood pressure after birth (weighted mean difference=3.61, 95%CI: 0.73-6.50, P=0.01), but it also increased the incidence rate of severe intraventricular hemorrhage (RR=1.83, 95%CI: 1.08-3.09, P=0.02). There were no significant differences between the two groups in hemoglobin, hematocrit, blood transfusion rate, proportion of infants undergoing phototherapy, bilirubin peak, and incidence rates of complications such as periventricular leukomalacia and necrotizing enterocolitis (P>0.05).@*CONCLUSIONS@#Compared with delayed cord clamping, umbilical cord milking may increase the risk of severe intraventricular hemorrhage in preterm infants with a gestational age of <34 weeks; however, more high-quality large-sample randomized controlled trials are needed for further confirmation.
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Female , Humans , Infant , Infant, Newborn , Pregnancy , Cerebral Hemorrhage , Constriction , Gestational Age , Infant, Premature , Prognosis , Umbilical Cord/physiology , Umbilical Cord ClampingABSTRACT
Background: The optimal timing of cord clamping has been a controversial issue for decades. Most practitioners in developing countries clamp and cut the cord immediately after birth and this takes place during the third stage of labour. World Health Organization advises late cord clamping, however there is a debate on the optimal time for cord clamping. Delayed umbilical cord clamping appears to be beneficial for term and preterm infants.Methods: This observational study was undertaken at Rajarajeswari Medical College and Hospital, Bangalore, Karnataka, India from June 2018 to January 2019.Results: Total 100 neonates were studied of which 48 were females (48%) and 52 were males (52%). 76 babies (76%) were 3 day old in this study and 24 babies were (24%) 4 day old during the study period. 92 babies (92%) didn't receive phototherapy in this study and 8 babies (8%) required phototherapy during the study period. No babies were polycythemic during this study period. Mean TB was 11.832 whereas mean DB was 0.5. Mean HCT was 56.332 and mean HB was 18.3002.Conclusions: Present study concluded that there are various advantages if authors practiced delayed cord clamping including higher levels of haemoglobin and haematocrit levels.
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Objective@#To investigate the effects of delayed cord clamping and early targeted care intervention on the infection control of premature infants.@*Methods@#A retrospective study of 362 premature babies admitted to our hospital from June 2016 to June 2017 was conducted. There are two groups based on the time of the broken navel. The control group (n=202) was the group with premature umbilical rupture. The observation group (n=160) was the late umbilicus breaking group. The umbilical cord complications, the residual blood volume of the placenta and the time of umbilical cord shedding were observed.@*Results@#The umbilical cord complications of premature infants were compared between the two groups. The incidence of umbilical hemorrhage, periumbilical redness, infection of umbilicus in the observed group was 1.88%(3/160), 2.50%(4/160), 3.75%(6/160), and the control group was 9.90%(20/202), 7.92% (16/202), and 13.27% (27/202), respectively. There were significant differences between the two groups (χ2=9.666, 5.026, 9.965, P<0.05). Umbilical cord abscission time and residual blood volume of placenta in the observation group were (7.36±2.18) d, (67.43±17.37) ml, and the control group were (9.98±3.18)d, (146.03±31.45)ml, with significant differences between the two groups (t=4.151, 13.577, P<0.05).@*Conclusions@#Delayed cord clamping can reduce the incidence of anemia and umbilical infection in premature infants, reducing the incidence of umbilical infection.but in clinical practice, it is recommended to select appropriate methods according to the condition of premature infants.
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Objective@#To investigate the influence of different delayed cord clamping(DCC) time on cerebral tissue oxygen saturation in normal newborns after birth and to explore the causes.@*Methods@#From November 2018 to February 2019, 164 healthy full term newborns were delivered in the Department of Obstetrics, Binhu Hospital, the Southern District of the Third Affiliated Hospital of Anhui Medical University.The newborns were divided into early cord clamping (ECC) group, DCC groups for 1 minute, 2 minutes and 3 minutes according to the different cord clamping time, and the changes of cerebral tissue oxygen saturation index (cTOI) and cerebral tissue hemoglobin index(cTHI) were monitored by near infrared spectroscopy (NIRS) for 15 minutes after birth.@*Results@#After birth, cTOI increased gradually but cTHI was basically stable.The cTOI in DCC group was higher than ECC group, but there was no difference between group 3 and group 4.In ECC group, the cTOI tended to be stable about 6 minutes after birth, and the stable range was 55%-59%.In DCC group, group 2 tended to be stable about 8 minutes after birth, and the stable range was 59%-64%.Group 3 and group 4 tended to be stable about 10 minutes after birth, the stable range was 64%-69%.There was no difference in cTHI among the groups.@*Conclusions@#Delayed cord clamping can increase cerebral oxygenation in newborns.The cause may not be due to the direct increase in cerebral blood flow, but the increase in brain oxygen content, and the optimal duration of DCC is 2 minutes.
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Objective To investigate the influence of different delayed cord clamping(DCC) time on cerebral tissue oxygen saturation in normal newborns after birth and to explore the causes.Methods From November 2018 to February 2019,164 healthy full term newborns were delivered in the Department of Obstetrics,Binhu Hospital,the Southern District of the Third Affiliated Hospital of Anhui Medical University.The newborns were divided into early cord clamping (ECC) group,DCC groups for 1 minute,2 minutes and 3 minutes according to the different cord clamping time,and the changes of cerebral tissue oxygen saturation index (cTOI) and cerebral tissue hemoglobin index (cTHI) were monitored by near infrared spectroscopy (NIRS) for 15 minutes after birth.Results After birth,cTOI increased gradually but cTHI was basically stable.The cTOI in DCC group was higher than ECC group,but there was no difference between group 3 and group 4.In ECC group,the cTOI tended to be stable about 6 minutes after birth,and the stable range was 55％-59％.In DCC group,group 2 tended to be stable about 8 minutes after birth,and the stable range was 59％-64％.Group 3 and group 4 tended to be stable about 10 minutes after birth,the stable range was 64％-69％.There was no difference in cTHI among the groups.Conclusions Delayed cord clamping can increase cerebral oxygenation in newborns.The cause may not be due to the direct increase in cerebral blood flow,but the increase in brain oxygen content,and the optimal duration of DCC is 2 minutes.
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Objective To investigate the effects of delayed cord clamping and early targeted care intervention on the infection control of premature infants. Methods A retrospective study of 362 premature babies admitted to our hospital from June 2016 to June 2017 was conducted. There are two groups based on the time of the broken navel. The control group (n=202) was the group with premature umbilical rupture. The observation group (n=160) was the late umbilicus breaking group. The umbilical cord complications, the residual blood volume of the placenta and the time of umbilical cord shedding were observed. Results The umbilical cord complications of premature infants were compared between the two groups. The incidence of umbilical hemorrhage, periumbilical redness, infection of umbilicus in the observed group was 1.88%(3/160), 2.50%(4/160), 3.75%(6/160), and the control group was 9.90%(20/202), 7.92% (16/202), and 13.27% (27/202), respectively. There were significant differences between the two groups (χ2=9.666, 5.026, 9.965, P<0.05). Umbilical cord abscission time and residual blood volume of placenta in the observation group were (7.36 ± 2.18) d, (67.43 ± 17.37) ml, and the control group were (9.98 ± 3.18)d, (146.03 ± 31.45)ml, with significant differences between the two groups (t=4.151, 13.577, P<0.05). Conclusions Delayed cord clamping can reduce the incidence of anemia and umbilical infection in premature infants, reducing the incidence of umbilical infection.but in clinical practice, it is recommended to select appropriate methods according to the condition of premature infants.
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Anemia of prematurity is one of the most common and serious problems affecting quality of life and survival of premature infants.Recent studies have found that delayed cord clamping or umbilical cord milking may prevent and control anemia of prematurity by providing a placental transfusion and elevating hemoglobin concentration.This review is a summary of current evidence on the effects of different umbilical cord handling on premature infants with anemia,with potential benefits and adverse effects discussed.
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Background: Delayed umbilical cord clamping is an effective strategy and particularly relevant for infants living in low-resource settings with less access to iron-rich foods and thus are at greater risk of anaemia. Objective: To compare the effect of umbilical cord milking (UCM) and delayed cord clamping (DCC) on haematological parameters (serum ferritin & hemoglobin) at birth and at 72 hours in term neonates. Methods: This was an Open Label Randomized Controlled Trial conducted at Suvidha Mother and Child Nursing Home Talab Tillo Jammu over a period of 6 months. A total of 68 babies born at > 37 weeks of gestation were randomized in three groups, group I UCM alone (n=28) , Group II DCC alone (n=23) and Group III both UCC and DCC (n=17) using simple randomization technique . In milking group, Umbilical cord was milked 4 times towards the baby at a speed of 10 cm / sec . In Delayed Cord Clamping group cord was clamped and cut 2-3 cm distance from the umbilical stump after 3 minutes of birth. In Group III both procedures were done simultaneously. Statistical analysis: ANOVAwas used to compare mean difference of outcome between three intervention arms. Two tailed Pvalue of <0.05 was taken as significant. SPSS version 20.0 was used for data analysis Results: The baseline characteristics were mostly comparable in the all the groups. Maximum increase in Haemoglobin and PCV was seen in group II i.e delayed cord clamping . Mean haemoglobin and heamatocrit (PCV) levels at 72 hours of life neonates in group II (17.7g% and 55.4 ) and group III (17.3g% and 54) were comparable . Conclusion: Both the interventions i.e Delayed cord clamping performed alone or in combination with umbilical cord milking had comparable effect on hematological status in term neonates
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Objective To investigate the effects of different umbilical cord ligation methods on anemia and jaundice in preterm infants with a gestational age less than 32 weeks.Methods A total of 135 preterm infants with a gestational age less than 32 weeks were recruited and randomly divided into the umbilical cord milking group,the delayed cord clamping group and the immediate cord clamping group,with 45 cases in each group.Comparisons among three groups were performed on hemoglobin,hematocrit at 1 h and 1 week after birth,and bilirubin peak,total time of phototherapy,the incidence of anemia,pathologic jaundice as well as polycythemia before discharge.Results Finally 40 cases in the umbilical cord milking group,42 cases in the delayed cord clamping group and 38 cases in the immediate cord clamping group were recruited.Compared with the immediate cord clamping group,Hb(g/L)and hematocrit(％) levels were significantly higher in the umbilical cord milking group and the delayed cord clamping group(P＜0.05),the anemia rate was significantly lower in umbilical cord milking group and the delayed cord clamping group(P＜0.05).However,there were no statistical differences in Hb(g/L) and hematocrit(％) levels as well as ane mia rate between the umbilical cord milking group and the delayed cord clamping group (P＞0.05).There were no significant differences among three groups in bilirubin peak,total time of phototherapy and the incidence of pathologic jaundice as well as polycythemia.Conclusion Umbilical cord milking and delayed cord clamping can both reduce the anemia rate,but not increase the risk of pathological jaundice.Umbilical cord milking can be preferred method for preterm infants with a gestational age less than 32 weeks and asphyxia.
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Objective To study the short-term effects of delayed cord clamping (DCC) in preterm infants.Method A thorough search was conducted on medical databases including Cochrane Library,PubMed,Ovid,Medline,VIP citation databases,Wanfang database and CNKI.Randomized control trials (RCTs) of DCC in preterm infants were retrieved from medical literature published during January 1,2000 to January 1,2016.DCC group had cord clamping 30 ～60 s after birth,and immediate cord clamping (ICC) group had cord clamping within 30 s after birth.Methodological quality was evaluated using Cochrane Handbook for systematic reviews and RevMan 5.1 software.Meta-analysis was performed using RevMan 5.1 software.Result Seventeen RCTs were included.Meta-analysis showed that:the blood pressure within 4 hours after birth (WMD =2.49,95％ CI 0.74 ～ 4.24),the hemoglobin concentration (WMD =15.92,95 ％ CI 6.37 ～ 25.47) and the hematocrit (WMD =4.84,95 ％ CI 3.47 ～ 6.22) within 24 hours after birth in the DCC group were higher than the ICC group,P ＜0.05;the risk of anemia (RR =0.62,95％ CI 0.47 ～ 0.81),intraventricular hemorrhage (RR =0.64,95 ％ CI 0.45 ～ 0.91) and mortality (RR =0.42,95％ CI 0.20 ～0.86) in the DCC group were lower than the ICC group,P ＜0.05;there were no statistically significant differences between the two groups in peak of serum bilirubin,phototherapy duration,rate of phototherapy treatment and blood transfusion,the incidence of hyperbilirubinemia and polycythemia (P ＞ 0.05).Conclusion DCC is safe and feasible for premature infants,and can improve the outcome of premature infants.
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PURPOSE: To evaluate the safety and feasibility of delayed cord clamping compared with umbilical cord milking in premature infants less than 32 weeks of gestation. METHODS: This study was performed by 1:2 case-control match. Infants received delayed cord clamping (DCC) for one minute (DCC group, n=10, May 2014-October 2015) were compared with perinatal factors-matching controls, who received umbilical cord milking (CM, CM group, n=20, May 2014-October 2015) or who received immediate cord clamping (ICC, ICC group, n=20, January 2008-December 2008). The primary outcome was hematocrit during the first 28 days. Secondary outcomes included delivery room management, selected neonatal morbidities and mortality. RESULTS: Baseline characteristics were comparable in all the three groups. The median hematocrit level at 1st day and 3rd day was significantly higher in the DCC group (54.3±6.2%, 53.6±5.6%) as compared with the CM group (48.0±7.7%, 43.2±7.8%) or ICC group (47.2±7.5%, 45.8±6.3%). The DCC group had reductions in red blood cell transfusion within the first two weeks of life compared to the CM group (10% vs. 50%, P=0.03). The DCC group compared to the CM group had no increment in respiratory intervention in the delivery room and hypothermia on admission. There was no difference between DCC and CM in mortality, intraventricular hemorrhage, bronchopulmonary dysplasia, necrotizing enterocolitis, severe retinopathy of prematurity and sepsis. CONCLUSION: Delayed cord clamping for 1 minute in preterm infants may be a safe and feasible method to increase initial hematocrit and reduce transfusion compared with umbilical cord milking.
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Humans , Infant , Infant, Newborn , Pregnancy , Bronchopulmonary Dysplasia , Case-Control Studies , Constriction , Delivery Rooms , Enterocolitis, Necrotizing , Erythrocyte Transfusion , Hematocrit , Hemorrhage , Hypothermia , Infant, Premature , Methods , Milk , Mortality , Retinopathy of Prematurity , Sepsis , Umbilical CordABSTRACT
ObjectiveTo study the effects of placental transfusion of umbilical cord milking on very low birth weight (VLBW) infants. Methods Fifty-seven VLBW infants born from September 2011 to May 2014 who had umbilical cord milking at birth were selected as experimental group. Sixty-one VLBW infants born from January 2008 to August 2011 who had normal cord clamping at birth were selected as control group. The complications of VLBW infants, blood transfusion, frequency of using pulmonary surfactant (PS), the duration of mechanical ventilation, the duration of oxygen and mortality were compared between two groups.Results The incidence of severe asphyxia, IVH and anemia was signiifcantly lower in experimental group than in control group (P< 0.05). The blood transfusion and transfusion volume, duration of mechanical ventilation, and duration of oxy-gen were signiifcantly lower in experimental group than in control group (P< 0.05).Conclusions Umbilical cord milking can reduce the incidence of severe asphyxia, IVH and anemia. It also can reduce the blood transfusion, the duration of mechanical ventilation, and the duration of oxygen in VLBW infants.
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Objective To systematically evaluate the effectiveness of delayed cord clamping (DCC) in term infants. Methods The data of the Cochrane library, PubMed, EMBASE, CNKI , VIP, Wanfang from 1 January 1970 to 30 April 2013 were searched. Randomized controlled trials (RCT) of DCC in term infants were included.RevMan 5.1.0 was used in the statis-tical analysis. Results Ten studies involving 1623 participants were included. Meta-analysis based on included studies showed that:compared with immediate cord clamping (ICC), DCC improved the hemoglobin levels at birth (MD=2.19, 95%CI:0.36, 4.02) and increased the incidence of polycythaemia (RR=2.87, 95%CI:1.24, 6.62). Compared with ICC, DCC showed no signi-ficant difference in the phototherapy for hyperbilirubinemia (RR=2.46, 95%CI: 0.93, 6.52), the hemoglobin levels within 6 months (MD=0.29, 95%CI:-0.17, 0.75), and the incidence of anemia (RR=0.71, 95%CI:0.45, 1.12). Conclusions DCC can improve the hemoglobin level in term infants after birth. However, the appropriate time of cord clamping has not been deter-mined. It is necessary to undertake further studies with higher quality and larger scale to evaluate the optimal time of cord clam-ping.