Early or delayed cord clamping during transition of term newborns: does it make any difference in cerebral tissue oxygenation?

BACKGROUND: According to the World Health Organization's recommendation, delayed cord clamping in term newborns can have various benefits. Cochrane metaanalyses reported no differences for mortality and early neonatal morbidity although a limited number of studies investigated long-term neurodevelopmental outcomes. The aim of our study is to compare the postnatal cerebral tissue oxygenation values in babies with early versus delayed cord clamping born after elective cesarean section. METHODS: In this study, a total of 80 term newborns delivered by elective cesarean section were included. Infants were randomly grouped as early (clamped within 15 s, n:40) and delayed cord clamping (at the 60th second, n:40) groups. Peripheral arterial oxygen saturation (SpO2) and heart rate were measured by pulse oximetry while regional oxygen saturation of the brain (rSO2) was measured with near-infrared spectrometer. Fractional tissue oxygen extraction (FTOE) was calculated for every minute between the 3rd and 15th minute after birth. (FTOE = pulse oximetry value-rSO2/pulse oximetry value). The measurements were compared for both groups. RESULTS: The demographical characteristics, SpO2 levels (except postnatal 6th, 8th, and 14th minutes favoring DCC p < 0.05), heart rates and umbilical cord blood gas values were not significantly different between the groups (p > 0.05). rSO2 values were significantly higher while FTOE values were significantly lower for every minute between the 3rd and 15th minutes after birth in the delayed cord clamping group (p < 0.05). CONCLUSION: Our study revealed a significant increase in cerebral rsO2 values and a decrease in FTOE values in the delayed cord clamping (DCC) group, indicating a positive impact on cerebral oxygenation and hemodynamics. Furthermore, the DCC group exhibited a higher proportion of infants with cerebral rSO2 levels above the 90th percentile. This higher proportion, along with a lower of those with such parameter below the 10th percentile, suggest that DCC may lead to the targeted/optimal cerebral oxygenetaion of these babies. As a result, we recommend measuring cerebral oxygenation, in addition to peripheral SpO2, for infants experiencing perinatal hypoxia and receiving supplemental oxygen.

Safety of different cord clamping strategies in the early postnatal period.

BACKGROUND: This study aimed to evaluate the effect of ICC (cord clamping within the first 15 s), DCC (delayed cord clamping at 60 s), and cut-UCM (cut-umbilical cord milking, cord clamping within the first 15 s) groups on oxygen saturation (SpO2), heart rate (HR), and perfusion index (PI) up to 10 min after birth in newborn infants. METHODS: We conducted this randomized clinical trial in the delivery unit of a University Hospital with 189 infants born between 35 and 42 weeks of gestation. Participants were randomly assigned to one of three groups: ICC, DCC, and cut-UCM. The primary outcomes measured were SpO2, HR, and PI at the 1st, 3rd, 5th, and 10th minutes after birth. We utilized ANOVA and Bayesian calculations in this study. RESULTS: There was no difference between the ICC, DCC, and cut-UCM groups in SpO2, HR, and PI values at the 1st, 3rd, 5th, and 10th minutes of life, which did not significantly alter between the three groups in one-way ANOVA. Bayesian repeated-measure ANOVA calculations showed that SpO2 and heart rate results at the 1st, 3rd, 5th, and 10th minutes did not differ between ICC, DCC, and cut-UCM techniques with strong evidence. At the 3rd minute, PI was slightly higher in the DCC and cut-UCM groups compared to the ICC group, with anecdotal evidence. We found no difference between DCC and cut-UCM regarding the 3rd-minute PI, with moderate evidence. CONCLUSION: Umbilical clamping procedures (ICC, DCC, and cut-UCM) did not affect SpO2 and HR in the first ten minutes of life, but 3rd-minute PI values were slightly higher in DCC and cut-UCM compared with ICC among late preterm and term neonates.

Regional pulmonary oxygen saturations in late preterm and term infants with respiratory distress at birth.

BACKGROUND: Measurement of regional pulmonary oxygen saturation by near-infrared spectroscopy is a novel monitorization method. This study aimed to determine the early regional pulmonary oxygen saturations in neonates with respiratory distress. METHODS: This observational study was conducted at the delivery room in infants above 35 weeks of gestation who developed respiratory distress immediately after birth. Preductal oxygen saturation (Covidien Nellcor®) and regional oxygen saturations of both apical (raSO2) and basal regions (rbSO2) of right lung were measured (Covidien INVOS®) within the first 15 min of life and compared to those of healthy neonates. RESULTS: Of the 165 infants included to the study, 15 were late preterm and 55 developed respiratory distress. Infants with respiratory distress had significantly lower gestational age and birth weight. Regional pulmonary oxygenations at both apex and basal lung areas were positively correlated with SpO2 in all infants. The rbSO2 was significantly lower than raSO2 until 10th minute of life regardless of respiratory distress. The fractionized tissue oxygen extraction of both apical and basal lung areas was significantly higher in infants with respiratory distress until 5th minute of life. CONCLUSION: This study is one of the pioneer studies evaluating the early pulmonary oxygenation values of infants with respiratory distress. Oxygenation of apical lung regions are better than basal areas. Higher fractionized tissue oxygen extraction showed the impaired pulmonary perfusion in infants with respiratory distress.