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Resuscitation. 2018 Oct;131:1-7. doi: 10.1016/j.resuscitation.2018.07.020. Epub 2018 Jul 20.

Baby-directed umbilical cord clamping: A feasibility study.

Author information

1
Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia. Electronic address: douglas.blank@thewomens.org.au.
2
Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia. Electronic address: shiraz.badurdeen@thewomens.org.au.
3
Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia. Electronic address: omar.kamlin@thewomens.org.au.
4
Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia. Electronic address: sue.jacobs@thewomens.org.au.
5
Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia. Electronic address: Marta.ThioLluch@thewomens.org.au.
6
Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia. Electronic address: Jennifer.Dawson@thewomens.org.au.
7
The University of Melbourne, Department of Obstetrics and Gynecology, Melbourne, Australia; Pregnancy Research Centre, The Royal Women's Hospital, Melbourne, Australia. Electronic address: Stefan.Kane@thewomens.org.au.
8
The University of Melbourne, Department of Obstetrics and Gynecology, Melbourne, Australia; Department of Anaesthesia, The Royal Women's Hospital, Melbourne, Australia. Electronic address: alicia.dennis@thewomens.org.au.
9
The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia. Electronic address: graeme.polglase@monash.edu.
10
The Ritchie Centre, Hudson Institute of Medical Research, Monash University, Melbourne, Australia. Electronic address: stuart.hooper@monash.edu.
11
Newborn Research Centre, The Royal Women's Hospital, Melbourne, Australia. Electronic address: pgd@unimelb.edu.au.

Abstract

INTRODUCTION:

Over five percent of infants born worldwide will need help breathing after birth. Delayed cord clamping (DCC) has become the standard of care for vigorous infants. DCC in non-vigorous infants is uncommon because of logistical difficulties in providing effective resuscitation during DCC. In Baby-Directed Umbilical Cord Clamping (Baby-DUCC), the umbilical cord remains patent until the infant's lungs are exchanging gases. We conducted a feasibility study of the Baby-DUCC technique.

METHODS:

We obtained antenatal consent from pregnant women to enroll infants born at ≥32 weeks. Vigorous infants received ≥2 min of DCC. If the infant received respiratory support, the umbilical cord was clamped ≥60 s after the colorimetric carbon dioxide detector turned yellow. Maternal uterotonic medication was administered after umbilical cord clamping. A paediatrician and researcher entered the sterile field to provide respiratory support during a cesarean birth. Maternal and infant outcomes in the delivery room and prior to hospital discharge were analysed.

RESULTS:

Forty-four infants were enrolled, 23 delivered via cesarean section (8 unplanned) and 15 delivered vaginally (6 via instrumentation). Twelve infants were non-vigorous. ECG was the preferred method for recording HR. Two infants had a HR < 100 BPM. All HR values were >100 BPM by 80 s after birth. Median time to umbilical cord clamping was 150 and 138 s in vigorous and non-vigorous infants, respectively. Median maternal blood loss was 300 ml.

CONCLUSIONS:

It is feasible to provide resuscitation to term and near-term infants during DCC, after both vaginal and cesarean births, clamping the umbilical cord only when the infant is physiologically ready.

KEYWORDS:

Cesarean; Delayed cord clamping; ECG; Heart rate; Newborn; Resuscitation; Uterotonic medication

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