Respiratory support after delayed cord clamping: a prospective cohort study of at-risk births at ≥35+0 weeks gestation.
Arch Dis Child Fetal Neonatal Ed
; 106(6): 627-634, 2021 Nov.
Article
in English
| MEDLINE | ID: covidwho-1503592
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 OUTCOMEMEASURES:
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.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Oxygen Inhalation Therapy
/
Umbilical Cord
/
Critical Pathways
/
Delivery, Obstetric
/
Electrocardiography
Type of study:
Cohort study
/
Observational study
/
Prognostic study
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
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