Effectiveness and safety of umbilical cord milking in premature infants: A randomized controlled trial.

INTRODUCTION: Both UCM and DCC are used to treat preterm infants, but there is no uniform standard for the length of UCM. The aim of this work was to explore the effectiveness and safety of different umbilical cord milking (UCM) lengths versus delayed cord clamping (DCC). METHODS: We enrolled premature infants from the Affiliated Hospital of Zunyi Medical University between September 2019 and October 2020 with random allocation (1:1:1:1) to the UCM 10 cm, UCM 20 cm, UCM 30 cm, and DCC groups. The primary outcome was hemoglobin at birth. RESULTS: Ultimately, 143 participants completed the trial (UCM 10 cm, n = 35; UCM 20 cm, n = 35; UCM 30 cm, n = 38; DCC, n = 35). The hemoglobin levels were significantly lower at birth in the UCM 10 cm group than in the UCM 20 and 30 cm and DCC groups (182.29 ±â€…22.15 vs 202.83 ±â€…21.46, 208.82 ±â€…20.72, and 198.46 ±â€…24.92, P = .001, .001, and .003, respectively). The systolic blood pressure and diastolic pressures in the UCM 30 cm group were higher than those in the UCM 10 and 20 cm and DCC groups at birth, postnatal day 3 and postnatal day 7 (P < .05). The occurrence rates of anemia were significantly higher in the UCM 10 cm group than in the UCM 20 and 30 cm and DCC groups (42.9% vs 14.3%, 10.5%, and 14.3%, all P < .0083). There were no significant differences in heart rate or complications among the 4 groups. CONCLUSIONS: A UCM of 20 or 30 cm is a safe, effective operation for preterm infants and could improve blood pressure and hemoglobin levels and reduce anemia.

Association between cerebral oximetry and return of spontaneous circulation following cardiac arrest: A systematic review and meta-analysis.

The present meta-analysis was based on the available studies to determine the potential role of the initial and regional cerebral oxygen saturation (rSO2) in monitoring the efficiency of cardiopulmonary resuscitation (CPR) and predicting the return of spontaneous circulation (ROSC). Three electronic databases of PubMed, Embase, and the Cochrane Library were searched to identify the studies that investigated the role of rSO2 on ROSC in CA patients throughout May 2018. The weighted mean difference (WMD) with 95% confidence interval (CI) was calculated to estimate the pooled effect using a random-effects model. Sensitivity, subgroup analyses, and publication bias were conducted. A total of 13 studies involving 678 CA patients (300 in-hospital (IH) patients, and 378 out-hospital (OH) patients) were included. The summary WMD suggested that ROSC patients were associated with higher initial rSO2 (WMD: 10.10%; 95% CI: 5.66-14.55; P<0.001) and mean rSO2 (WMD: 14.16%; 95% CI: 10.51-17.81; P<0.001) levels during CA and ROSC as compared to the non-ROSC. The results of meta-regression suggested that the male percentage and the location of cardiac arrest might bias the initial or mean rSO2 and the incidence of ROSC. These significant differences were observed in nearly all subsets. The findings of this study suggested that high initial or mean rSO2 levels were both associated with an increased incidence of ROSC in CA patients undergoing CPR. These correlations might be affected by the percentage of males or the location of cardiac arrest, thereby necessitating further large-scale studies to substantiate whether these correlations differ according to gender and the location of cardiac arrest.