Physiologically based cord clamping for infants ≥32+0 weeks gestation: A randomised clinical trial and reference percentiles for heart rate and oxygen saturation for infants ≥35+0 weeks gestation

• DOI: 10.1371/journal.pmed.1004029
• Publication Date: 2022-06-23T17:45:50Z
• Authors: Shiraz Badurdeen; Peter G. Davis; Stuart B. Hooper; Susan Donath; Georgia A. Santom...; Alissa Heng; Diana Zannino; Monsurul Hoq; C. Omar F Kamlin; Stefan C. Kane; Anthony Woodward; Calum T. Roberts; Graeme R. Polglase; Douglas A. Blank
• Keywords: Interquartile range; Neonatal Resuscitation; Cardiotocography

Background Globally, the majority of newborns requiring resuscitation at birth are full term or late-preterm infants. These infants typically have their umbilical cord clamped early (ECC) before moving to a platform, losing potential support placental circulation. Physiologically based clamping (PBCC) is after establishing lung aeration and holds promise as readily available means improving newborn outcomes. In mechanically ventilated lambs, PBCC improved cardiovascular stability reduced hypoxia. We hypothesised that compared ECC would result in higher heart rate (HR) needing resuscitation, without compromising safety. Methods findings Between 4 July 2018 18 May 2021, born ≥32 +0 weeks’ gestation with paediatrician called attend were enrolled parallel-arm randomised trial 2 Australian perinatal centres. Following initial stimulation, further within 60 seconds using smartphone-accessible web link. The intervention was establish aeration, either via positive pressure ventilation (PPV) effective spontaneous breathing, prior clamping. comparator resuscitation. primary outcome mean HR between 120 birth, measured 3-lead electrocardiogram, extracted from video recordings blinded group allocation. Nonrandomised had deferred (DCC) ≥120 observational study arm. Among 508 at-risk enrolled, 123 ( n = 63 PBCC, ECC). Median (interquartile range, IQR) for gestational age 39.9 (38.3 40.7) weeks 39.6 (38.4 40.4) Approximately 49% 50% female, respectively. Five (PBCC 2, 3, 4% total) missing data. Cord occurred median (IQR) 136 (126 150) arm 37 (27 51) Mean 154 bpm (beats per minute) versus 158 (adjusted difference −6 bpm, 95% confidence interval (CI) −17 5 P 0.39). 31 secondary outcomes, postpartum haemorrhage ≥500 ml 34% 32% mothers arms, Two hundred ninety-five nonrandomised (55% female) (38.6 40.6) received DCC. Data these used create percentile charts expected oxygen saturation vigorous receiving limited by small number prolonged advanced may provide other important benefits we did not measure, including maternal–infant bonding iron stores. Conclusions this study, observed resulted similar ECC. suggest who receive brief, closely monitored births, does additional benefit over (performed drying stimulation) terms key physiological markers transition. feasible simple, low-cost strategy both cesarean vaginal births. guide clinicians monitoring transition Trial registration New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618000621213 .