Late umbilical cord clamping does not increase rates of jaundice and the need for phototherapy in pregnancies at normal risk

Objective: To verify the relationship between the time of clamping of the umbilical cord and the development of neonatal jaundice, the dosage of bilirubin and the need for phototherapy.

Methods: Cross-sectional, retrospective study with 398 parturients at normal risk (single term gestation, no complications during gestation or delivery, birth weight between 2500 and 4499?g). The population was divided into three groups regarding the time of cord clamping: <1?min(117, 29.4%), between 1 and 3?min(228, 57.3%) and >3?min(53, 13.3%). Sociodemographic, clinical and obstetric characteristics, birth and delivery data, and maternal and perinatal outcomes were evaluated. Pearson’s chi-square test, Fisher’s exact test and the Kruskal–Wallis test were used for comparison between the groups. Statistical significance was considered p?Results: The groups were similar in the development of jaundice (p?=?.370), bilirubin dosage (p?=?.342) and need for phototherapy (p?=?.515). Late clamping was more prevalent in vaginal deliveries when compared to cesarean sections (1–3?min: 64 versus 21.4%, >3?min: 16.6 versus 1%) (p?Conclusion: The clamping time of the umbilical cord showed no association with jaundice, bilirubin dosage, or phototherapy needs in neonates at normal risk. The adoption of late clamping was more prevalent in vaginal deliveries.     

Role of delayed cord clamping in prevention of necrotizing enterocolitis in preterm neonates: a systematic review

Background: Necrotizing enterocolitis (NEC) is one of the leading causes of neonatal mortality and morbidity particularly in very-low-birth-weight (VLBW) neonates. The incidence of NEC varies across countries and neonatal centers in between 7% and 14%.

Aims: The aim of this study is to evaluate the role of delayed cord clamping (DCC) for prevention of NEC in preterm neonates.

Method: The literature search was done for various randomized control trial (RCT) by searching the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, ongoing clinical trials, and abstract of conferences.

Results: This review included six RCTs that fulfilled inclusion criteria. There was statistically significant reduction in the incidence of NEC in DCC group (12.2% versus 20.6%; risk ratio (RR) 0.59; 95% CI 0.37–0.94; p?=?.02; number needed to treat (NNT) 12). However, mortality due to any cause before hospital discharge was not statistically significant (RR 0.80; 95% CI 0.33–2.00; p?=?.64).

Conclusion: The role of DCC in the prevention of NEC is supported by the current evidences. However, given the small sample sizes and other limitations of these studies, current evidences are not sufficient. We need large high-quality trials, with sufficient power to reliably assess clinically relevant differences in important outcomes.

Trial registration: ClinicalTrials.gov identifier: NCT02996799.

Trial registration: ClinicalTrials.gov identifier: NCT02092103.     

Delayed cord clamping and inotrope use in preterm infants

Objective: To evaluate the impact of delayed cord clamping (DCC) on need for inotropic support and mean arterial blood pressure (MABP).

Methods: This is a single-center, prospective case-control study of premature infants, born <32 weeks gestation, who underwent DCC in comparison to a matched control group who underwent immediate cord clamping (ICC). The primary outcomes were the differences in MABP and inotropic medication used over the first week of life. Secondary outcomes included the admission hemoglobin, need for blood transfusion, and rates of intraventricular hemorrhage (IVH). Infants were matched on EGA, birth weight, sex, antenatal corticosteroid and magnesium exposure, and presence of chorioamnionitis.

Results: Hundred and fifty-eight infants (DCC n?=?79, ICC n?=?79) were included. Demographic factors were similar between groups. DCC infants had a higher admission hemoglobin (p?p?=?.03), fewer median transfusions (p?=?.03), and were discharged at an earlier post-menstrual age (p?=?.04). When controlling for other factors, DCC was not associated with a reduction in inotrope use (p?=?.22) but was associated with a reduction in high-grade IVH (p?=?.01). There was no difference in MABP between the groups.

Conclusions: DCC is not associated with a reduction in the use of inotropes or a difference in MABP.     

A review of benefits of cord milking over delayed cord clamping in the preterm infant and future directions of research

Purpose of review: The recommended method of handling the umbilical cord has undergone a complete 360° turn over the years and current knowledge and research has led the direction to delayed clamping and cord milking. This practice has also been supported by American College of Obstetrics and Gynecology (ACOG) in 2012. This review is a summary of current evidence on delayed cord clamping (DCC), umbilical cord milking (UCM), and comparison between the two and future directions.

Recent findings: Multiple studies have been published establishing the safety of umbilical cord milking. Data comparing UCM to DCC favor milking specifically in terms of improved systemic perfusion and higher hemoglobin concentrations.

Summary: UCM is emerging as a safe, quick alternative to DCC and more advantageous especially among premature infants and those delivered via cesarean section.     

Clamp late and maintain perfusion (CLAMP) policy: delayed cord clamping in preterm infants

Objective: Randomized controlled trials have demonstrated that delayed umbilical cord clamping (DCC) in preterm infants results in improved neonatal outcomes, including increased hematocrit, and decreased rates of intraventricular hemorrhage (IVH) and packed red blood cell transfusions. We hypothesized that implementation of a DCC policy in preterm infants would result in similarly improved outcomes, despite initial clinician resistance.

Study design: A DCC policy (30–60?s) for singleton infants <35 weeks gestation was implemented in September 2011. We conducted a pre-test/post-test analysis of neonatal outcomes among singletons delivered between 24 0/7 weeks and 34 6/7 weeks gestation from 2009 to 2013 (2 years pre-implementation and 2 years post-implementation). The primary outcomes were rates of policy compliance and four neonatal outcomes.

Results: Despite multiple routes of policy dissemination, DCC was attempted in only 49% of the deliveries. In spite of this, infants delivered post-policy implementation (n?=?196) had a significant decrease in IVH, significant increase in initial hematocrits, and improved temperatures compared with infants delivered pre-implementation (n?=?204).

Conclusion: After implementation of a DCC policy, preterm singleton infants had improved temperatures, increased hematocrits and a decreased prevalence of IVH without significant differences in adverse outcomes, suggesting that the benefits of DCC outweighed the risks.     

Relationship between the cortisol levels in umbilical cord blood and neonatal RDS/TTN in twin pregnancies

Objective: Twin neonates have a higher risk of respiratory complications, such as respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN), than singleton neonates. The purpose of this study was to evaluate the relationship between the cortisol levels in the umbilical cord and neonatal RDS/TTN in twin pregnancies.

Methods: We analyzed data obtained from 106 neonates (53 twin pairs), comprising 33 dichorionic twin (DCT) and 20 monochorionic twin (MCT) gestations. All infants were delivered via scheduled cesarean section without labor. We measured the cortisol levels in umbilical vein blood using enzyme-linked immunosorbent assay.

Results: The cortisol levels in the umbilical vein were significantly lower in the RDS/TTN group than in the no RDS/TTN group (p = 0.004). The umbilical cortisol levels in the TTN group were between the values observed in the RDS group and no RDS/TTN group. We subsequently analyzed the cut-off cortisol values for RDS/TTN and observed higher accuracy in the DCTs than in the MCTs.

Conclusions: Neonates who develop RDS/TTN have significantly lower cortisol levels in the umbilical cord at birth than no RDS/TTN neonates in twin pregnancies. When applying these data in clinical practice, physicians should pay attention to differences based on chorionicity.     

Hypoxic ischemic encephalopathy in newborns linked to placental and umbilical cord abnormalities

Objective: Birth asphyxia and hypoxic ischemic encephalopathy (HIE) of the newborn remain serious complications. We present a study investigating if placental or umbilical cord abnormalities in newborns at term are associated with HIE.

Materials and methods: A prospective cohort study of the placenta and umbilical cord of infants treated with hypothermia (HT) due to hypoxic brain injury and follow-up at 12 months of age has been carried out. The study population included 41 infants treated for HT whose placentas were submitted for histopathological analysis. Main outcome measures were infant development at 12 months, classified as normal, cerebral palsy, or death. A healthy group of 100 infants without HIE and normal follow-up at 12 months of age were used as controls.

Results: A velamentous or marginal umbilical cord insertion and histological abruption was associated with the risk of severe HIE, OR?=?5.63, p?=?0.006, respectively, OR?=?20.3, p?=?0.01 (multiple-logistic regression). Velamentous or marginal umbilical cord insertion was found in 39% among HIE cases compared to 7% in controls.

Conclusions: Placental and umbilical cord abnormalities have a profound association with HIE. A prompt examination of the placentas of newborns suffering from asphyxia can provide important information on the pathogenesis behind the incident and contribute to make a better early prognosis.     

Effects and safety of delayed versus early umbilical cord clamping in newborns of HIV-infected mothers

Objective: To investigate the effect of a 2 minutes-delayed cord clamp (DCC) versus early cord clamp (ECC) on neonate haemoglobin concentration 24 hours and 1 month after birth, and assess the safety of DCC concerning the risk of HIV infection.

Design: Sixty-four mother-infant peers were enrolled. All mothers were on stable ARV therapy. Viral load, CD4⁺ count and blood haemoglobin (Hb) concentrations 24 hours before delivery were collected from all mothers and their infants.

Methods: All patients were enrolled at the Department of Paediatrics, AO FBF Sacco Hospital in Milan, and were followed until 18 months after birth. Women with haematological diseases and obstetrical complications were excluded. All of 64 mother and infants couples (32 ECC group and 32 DCC group) completed the study. ECC and DCC are defined as application of umbilical clamp within 30 seconds and 120 seconds after birth, respectively.

Results: Mean birth weight was significantly higher in the DCC compared with ECC group. Mean Hb levels at birth were significantly higher in DCC than in ECC group (p?=?.05): this difference persisted at 1 month of life. All newborns showed negative viral load.

Conclusions: DCC 2 minutes after birth is proven to be a safe procedure, particularly beneficial in newborns from HIV mothers. The risk of anemia is significantly decreased at 24 hours after birth and persists at age of 1 month without any increased risk of neonatal jaundice or polycitemia.     

糖代谢异常孕妇脐血血脂与新生儿体质指数的关系

目的 探讨在血糖控制良好的糖代谢异常的孕妇中,脐血血脂与新生儿体质指数的关系. 方法 收集2006年11月至2007年2月住院分娩的孕妇150例,其中糖代谢异常(包括妊娠期糖尿病和妊娠期糖代谢异常)且血糖控制良好的孕妇73例,糖耐量正常的孕妇77例,其新生儿分为大于胎龄儿(large for gestational age,LGA)25例和适于胎龄儿(appropriate forgestational age,AGA)125例两组.分析两组新生儿的体质指数、脐血血脂[包括高密度脂蛋白(high density lipoprotein,HDL)、低密度脂蛋白(low density lipoprotein,LDL)、甘油三酯(triglyceride,TG)、总胆固醇(total cholestrol,TC)]等指标,并对上述指标进行比较和相关、回归分析. 结果 脐血HDL、LDL、TC水平在两组间无差异,脐血TG水平LGA组高于AGA组[(0.23±0.16)mmol/L和(0.14±0.08)mmol/L,P＜0.05].在糖代谢异常孕妇的新生儿中,LGA儿的出生体重与脐血TG水平正相关(r=0.625,P＜0.05),与脐血HDL、LDL、TC不相关.在糖耐量正常孕妇的新生儿中,LGA儿的体质指数与脐血血脂指标均不相关.分娩LGA儿的危险因素为:孕期增重≥18 kg,脐血TG＞0.11 mmol/L. 结论 血脂代谢与新生儿体质指数密切相关;脐血TG可能参与了精代谢异常孕妇分娩LGA的发病机制;脐血TG＞0.11 mmol/L时更容易发生LGA.     

The correlation between automated hematology and manually read smears for the determination of nucleated red blood cells in umbilical cord blood

Objective.?To determine the correlation between automated hematology nucleated red blood cell counts and manual counts in umbilical cord blood.

Methods.?Umbilical cord venous blood was obtained after cord clamping at the time of delivery. The number of nucleated red blood cells per one hundred white blood cells was measured using an automated hematology analyzer and compared with direct microscopic visualization of prepared slides by experienced hematology technicians.

Results.?The umbilical cord blood from 128 women was studied. The mean, median and standard deviations of nucleated red blood cell counts were not significantly different between the automated reading and the manual reading (mean 9.3?±?11.2 versus 9.1?±?13.1, respectively, P?=?0.76; median 5.9 versus 5.0, P?=?0.95; range 0–77, 0–105). Automated derived nucleated red blood cell counts and manual numbers were highly correlated with a correlation coefficient of 0.794.

Conclusion.?The automated hematology analyzer readings of nucleated red blood cell counts correlate well with readings by laboratory hematologists.     

Umbilical cord serum vascular endothelial growth factor (VEGF) levels in normal pregnancies and in pregnancies complicated by preterm delivery or pre-eclampsia.

OBJECTIVES: The aim of this study was to determine whether increased levels of vascular endothelial growth factor (VEGF) are implicated in the pathogenesis of pre-eclampsia and in preterm delivery. METHODS: Umbilical cord serum VEGF levels from women with uncomplicated term pregnancies (control group, n=24), with pregnancies complicated by pre-eclampsia (n=21), or with preterm delivery (n=29) were compared. Statistical analysis was performed using the Mann-Whitney U-test, the t-test, and Smirnoff-Kolmogorov test. RESULTS: The mean VEGF concentration was significantly higher in the women with pre-eclampsia than in women from the control group (P<0.01). There were also increased but not significantly higher VEGF concentrations in the preterm delivery group compared with the control group (P=0.16). CONCLUSIONS: Our study results support previous findings that raised umbilical cord serum VEGF levels might be correlated with the clinical development of pre-eclampsia and, in some circumstances, of preterm delivery.     

High correlations in gene expression between paired umbilical cord blood and neonatal blood of healthy newborns on Guthrie cards

Abstract

Objective: To examine the correlation in genes expressed in paired umbilical cord blood (UCB) and newborn blood (NB).

Method: Total mRNA and mRNA of three gene sets (inflammatory, hypoxia, and thyroidal response) was assessed using microarray in UCB and NB spotted on Guthrie cards from 7 mother/infant pairs.

Results: The average gene expression correlation between paired UCB and NB samples was 0.941 when all expressed genes were considered, and 0.949 for three selected gene sets.

Conclusion: The high correlation of UCB and NB gene expression suggest that either source may be useful for examining gene expression in the perinatal period.     

人脐带间充质干细胞移植对围绝经期大鼠INHB和AMH的影响

目的:探讨人脐带间充质干细胞(h UCMSCs)移植对围绝经期大鼠AMH、INHB的影响。方法:阴道脱落细胞涂片筛选30只13~15月龄的SPF级SD围绝经期大鼠模型,随机分为A、B、C组(每组10只)。A组不予处理;B组经尾静脉移植浓度1×106细胞/ml h UCMSCs 1ml,隔日1次,共2次;C组移植等量的细胞培养液。于成模时和末次移植后7天和14天,检测各组大鼠的AMH、INHB水平。结果:3组成模时及末次移植后7天的AMH、INHB水平比较,差异均无统计学意义(P0.05)。末次移植后14天,B组的AMH、INHB水平高于A、C组,差异有统计学意义(P0.05);移植后,A、C组的AMH、INHB水平逐渐下降,移植后第14天时下降显著,与成模时比较差异有统计学意义(P0.05)。结论:h UCMSCs移植可延缓围绝经期SD大鼠AMH、INHB下降水平,提示对延缓围绝经期大鼠卵巢储备功能下降有积极意义。