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Respiratory support after delayed cord clamping: a prospective cohort study of at-risk births at ≥35+0 weeks gestation.
Badurdeen, Shiraz; Santomartino, Georgia A; Thio, Marta; Heng, Alissa; Woodward, Anthony; Polglase, Graeme R; Hooper, Stuart B; Blank, Douglas A; Davis, Peter G.
  • Badurdeen S; Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia Shiraz.Badurdeen@thewomens.org.au.
  • Santomartino GA; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.
  • Thio M; Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia.
  • Heng A; Newborn Research Centre, Royal Women's Hospital, Parkville, Victoria, Australia.
  • Woodward A; Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia.
  • Polglase GR; Department of Obstetrics, Royal Women's Hospital Department of Obstetrics and Gynaecology, Melbourne, Victoria, Australia.
  • Hooper SB; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.
  • Blank DA; Obstetrics and Gynaecology, Monash University Faculty of Medicine, Nursing and Health Sciences, Clayton, Victoria, Australia.
  • Davis PG; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.
Arch Dis Child Fetal Neonatal Ed ; 106(6): 627-634, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1503592
Semantic information from SemMedBD (by NLM)
1. risk factors PROCESS_OF Infant
Subject
risk factors
Predicate
PROCESS_OF
Object
Infant
2. Closure by clamp ADMINISTERED_TO Physicians
Subject
Closure by clamp
Predicate
ADMINISTERED_TO
Object
Physicians
3. heart rate average PROCESS_OF Infant
Subject
heart rate average
Predicate
PROCESS_OF
Object
Infant
4. Closure by clamp PRECEDES Close observation
Subject
Closure by clamp
Predicate
PRECEDES
Object
Close observation
5. Close observation TREATS Infant
Subject
Close observation
Predicate
TREATS
Object
Infant
6. risk factors PROCESS_OF Infant
Subject
risk factors
Predicate
PROCESS_OF
Object
Infant
7. Closure by clamp ADMINISTERED_TO Physicians
Subject
Closure by clamp
Predicate
ADMINISTERED_TO
Object
Physicians
8. heart rate average PROCESS_OF Infant
Subject
heart rate average
Predicate
PROCESS_OF
Object
Infant
9. Closure by clamp PRECEDES Close observation
Subject
Closure by clamp
Predicate
PRECEDES
Object
Close observation
10. Close observation TREATS Infant
Subject
Close observation
Predicate
TREATS
Object
Infant
ABSTRACT

OBJECTIVE:

To identify risk factors associated with delivery room respiratory support in at-risk infants who are initially vigorous and received delayed cord clamping (DCC).

DESIGN:

Prospective cohort study.

SETTING:

Two perinatal centres in Melbourne, Australia. PATIENTS At-risk infants born at ≥35+0 weeks gestation with a paediatric doctor in attendance who were initially vigorous and received DCC for >60 s. MAIN OUTCOME

MEASURES:

Delivery room respiratory support defined as facemask positive pressure ventilation, continuous positive airway pressure and/or supplemental oxygen within 10 min of birth.

RESULTS:

Two hundred and ninety-eight infants born at a median (IQR) gestational age of 39+3 (38+2-40+2) weeks were included. Cord clamping occurred at a median (IQR) of 128 (123-145) s. Forty-four (15%) infants received respiratory support at a median of 214 (IQR 156-326) s after birth. Neonatal unit admission for respiratory distress occurred in 32% of infants receiving delivery room respiratory support vs 1% of infants who did not receive delivery room respiratory support (p<0.001). Risk factors independently associated with delivery room respiratory support were average heart rate (HR) at 90-120 s after birth (determined using three-lead ECG), mode of birth and time to establish regular cries. Decision tree analysis identified that infants at highest risk had an average HR of <165 beats per minute at 90-120 s after birth following caesarean section (risk of 39%). Infants with an average HR of ≥165 beats per minute at 90-120 s after birth were at low risk (5%).

CONCLUSIONS:

We present a clinical decision pathway for at-risk infants who may benefit from close observation following DCC. Our findings provide a novel perspective of HR beyond the traditional threshold of 100 beats per minute.
Subject(s)
Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Oxygen Inhalation Therapy / Umbilical Cord / Critical Pathways / Delivery, Obstetric / Electrocardiography Type of study: Etiology study / Clinical Practice Guide / Observational study / Prognostic study / Risk factors Limits: Female / Humans / Male / Infant, Newborn Country/Region as subject: Oceania Language: English Journal: Arch Dis Child Fetal Neonatal Ed Journal subject: Pediatrics / Perinatology Year: 2021 Document Type: Article Affiliation country: Archdischild-2020-321503

Full text: Available Collection: International databases Database: MEDLINE Main subject: Oxygen Inhalation Therapy / Umbilical Cord / Critical Pathways / Delivery, Obstetric / Electrocardiography Type of study: Etiology study / Clinical Practice Guide / Observational study / Prognostic study / Risk factors Limits: Female / Humans / Male / Infant, Newborn Country/Region as subject: Oceania Language: English Journal: Arch Dis Child Fetal Neonatal Ed Journal subject: Pediatrics / Perinatology Year: 2021 Document Type: Article Affiliation country: Archdischild-2020-321503