Timing of umbilical cord occlusion, delayed vs early, in preterm babies: A randomized controlled trial (CODE-P Trial).

INTRODUCTION: Our hypothesis was that delayed cord clamping (DCC) (not earlier than 30 s; at 30-60 s) in premature neonates (born between 26.0 and 32.6 weeks of gestation), as compared with the usual early cord clamping (ECC), significantly reduces the need for blood transfusions and incidence of intraventricular haemorrhage (IVH) without an increased rate of maternal postpartum haemorrhage. MATERIAL AND METHODS: A prospective, open-label, randomized, controlled trial was conducted at Vall d'Hebron Hospital from July 2014 to December 2018. All pregnant women at risk of impending preterm birth (≥26.0-<33.0 weeks of gestation) who were admitted to the obstetrics emergency department were evaluated for eligibility. If they met the eligibility criteria, they were invited to participate in the study and, if they agreed, they signed an informed consent. Patients were randomly assigned to one of two groups: ECC group and DCC group. RESULTS: Our study included a total of 57 patients: 30 in the ECC group and 27 in the DCC group. Due to a lack of funding and low recruitment rates, the study was discontinued in 2018. Maternal characteristics and obstetric outcomes were similar between both groups. The intention-to-treat analysis did not reveal any differences between groups for neonatal red blood cell transfusions, neonatal IVH or maternal postpartum haemorrhage. There were no differences for secondary outcomes. Similarly, no differences were observed in the as-treated analysis. CONCLUSION: The primary and secondary outcomes of our study were not achieved. Therefore, more meta-analysis and trials are needed to evaluate the appropriate timing of cord clamping in preterm birth.

Criopreservación ovárica en niñas con cáncer: nuevos retos / Ovarian cryopreservation in girls with cancer: new challenges

Objetivos. La criopreservación de la corteza ovárica (CCO) para futuro autotrasplante permitirá hacer frente al fallo ovárico precoz y a las alteraciones de la capacidad reproductiva que afectan a algunas delas supervivientes de cáncer pediátrico. Material y métodos. En el Programa de Preservación de Fertilidad en Oncología Pediátrica se incluyen pacientes con alto riesgogonadotóxico: las que vayan a recibir radioterapia pélvica, trasplante de precursores hematopoyéticos, altas dosis de radioterapia craneal o agentes alquilantes, o aquéllas con patología ovárica bilateral. Antes del tratamiento oncológico y coincidiendo con otros procedimientos invasivos, se recoge el tejido ovárico por vía laparoscópica. Una vez descartada la malignidad en la muestra y confirmada la presencia de folículos primordiales, el equipo multidisciplinar de oncólogo, cirujano y especialista en fertilidad coordina la manipulación y envío de la corteza ovárica al Banco de Tejidos de la Comunidad Valenciana. Resultados. De julio de 2008 hasta mayo de 2010 se incluyeron en el programa a 8 pacientes, entre 8 y 18 años, con diagnóstico de: linfoma de Hodgkin (n= 2), leucemia aguda linfoide y mieloide (n= 2),sarcoma de Ewing pélvico, teratoma ovárico bilateral y meduloblastoma. Cinco pacientes recibieron quimioterapia no gonadotóxica previa a la CCO. De forma adicional, se practicaron 6 procedimientos en el mismo acto anestésico. Se realizó o oforectomía parcial en la mitad delos casos y total en el resto, asociando pexia ovárica en 1 ocasión. Todas las muestras fueron válidas. Conclusiones. La CCO de los casos seleccionados se realizó de forma segura, sin complicaciones ni demora del tratamiento oncológico. Podemos afi rmar que la primera experiencia nacional en este tipo de abordaje ha sido satisfactoria (AU)

Background. Ovarian cortex cryopreservation (OCC) for future autotransplant represents a treatment alternative for those paediatriccancer survivors affected of ovarian failure and fertility disorders. Methods. Patients with high gonadotoxic risk are included in the Oncology Paediatric Fertility Preservation Programme: those receiving pelvic radiotherapy, bone marrow transplantation, high doses of cranial radiotherapy or alquilating agents, or those with bilateral ovarian pathology. Prior to the oncological treatment, the ovarian tissue is harvested laparoscopically. At the same time, other invasive procedures are done. Once malignancy is ruled out of the specimen and the presence of primordial follicles is confirmed, the multidisciplinary team of oncologist, paediatric surgeon and fertility specialist coordinate the processing and delivery of the ovarian cortex to the Comunidad ValencianaTissue Bank. Results. From July 2008 to May 2010 eight patients have been included in the programme, aged between 8-18 years old and with diagnosis of: Hodgkin’s lymphoma (n= 2), Acute Myeloblastic and Lymphoblasticleukaemia (n= 2), pelvic Ewing’s sarcoma, bilateral ovarian Teratoma and Meduloblastoma. Five patients underwent non gonadotoxicchemo therapy before OCC. Six additional procedures were doneusing the same anaesthetic event. Partial oophorectomy was performed in half the cases, total oophorectomy in the rest of them, and an ovarianpexia was once associated. All taken samples were found to be valid. Conclusions. OCC of selected patients was performed safely, with neither postoperative complications nor delay of the oncological treatment. Therefore, the fi rst national experience in this procedure has been satisfactorily achieved (AU)

[Ovarian cryopreservation in girls with cancer: new challenges]. / Criopreservación ovárica en niñas con cáncer: nuevos retos.

BACKGROUND: Ovarian cortex cryopreservation (OCC) for future autotransplant represents a treatment alternative for those paediatric cancer survivors affected of ovarian failure and fertility disorders. METHODS: Patients with high gonadotoxic risk are included in the Oncology Paediatric Fertility Preservation Programme: those receiving pelvic radiotherapy, bone marrow transplantation, high doses of cranial radiotherapy or alquilating agents, or those with bilateral ovarian pathology. Prior to the oncological treatment, the ovarian tissue is harvested laparoscopically. At the same time, other invasive procedures are done. Once malignancy is ruled out of the specimen and the presence of primordial follicles is confirmed, the multidisciplinary team of oncologist, paediatric surgeon and fertility specialist coordinate the processing and delivery of the ovarian cortex to the Comunidad Valenciana Tissue Bank. RESULTS: From July 2008 to May 2010 eight patients have been included in the programme, aged between 8-18 years old and with diagnosis of: Hodgkin's lymphoma (n= 2), Acute Myeloblastic and Lymphoblastic leukaemia (n= 2), pelvic Ewing's sarcoma, bilateral ovarian Teratoma and Meduloblastoma. Five patients underwent non gonadotoxic chemotherapy before OCC. Six additional procedures were done using the same anaesthetic event. Partial oophorectomy was performed in half the cases, total oophorectomy in the rest of them, and an ovarian pexia was once associated. All taken samples were found to be valid. CONCLUSIONS: OCC of selected patients was performed safely, with neither postoperative complications nor delay of the oncological treatment. Therefore, the first national experience in this procedure has been satisfactorily achieved.