Department of Neonatology, Women & Infants Hospital of Rhode Island & Alpert Medical School of Brown University, Providence, RI 02905, USA.
Pediatrics. 2012 Mar;129(3):e667-72. doi: 10.1542/peds.2011-2550. Epub 2012 Feb 13.
Delayed cord clamping (DCC) has been advocated during preterm delivery to improve hemodynamic stability during the early neonatal period. The hemodynamic effects of DCC in premature infants after birth have not been previously examined. Our objective was to compare the hemodynamic differences between premature infants randomized to either DCC or immediate cord clamping (ICC).
This prospective study was conducted on a subset of infants who were enrolled in a randomized controlled trial to evaluate the effects of DCC versus ICC. Entry criteria included gestational ages of 24(0) to 31(6) weeks. Twins and infants of mothers with substance abuse were excluded. Serial Doppler studies were performed at 6 ± 2, 24 ± 4, 48 ± 6, and 108 ± 12 hours of life. Measurements included superior vena cava blood flow, right ventricle output, middle cerebral artery blood flow velocity (BFV), superior mesenteric artery BFV, left ventricle shortening fraction, and presence of a persistent ductus arteriosus.
Twenty-five infants were enrolled in the DCC group and 26 in the ICC group. Gestational age, birth weight, and male gender were similar. Admission laboratory and clinical events were also similar. DCC resulted in significantly higher superior vena cava blood flow over the study period, as well as greater right ventricle output and right ventricular stroke volumes at 48 hours. No differences were noted in middle cerebral artery BFV, mean superior mesenteric artery BFV, shortening fraction, or the incidence of a persistent ductus arteriosus.
DCC in premature infants is associated with potentially beneficial hemodynamic changes over the first days of life.
延迟脐带夹闭（DCC）在早产儿分娩时被提倡，以改善新生儿早期的血液动力学稳定性。此前，尚未研究 DCC 对早产儿出生后的血液动力学影响。我们的目的是比较随机分为 DCC 或即刻脐带夹闭（ICC）的早产儿之间的血液动力学差异。
这项前瞻性研究是在一项随机对照试验的一部分婴儿中进行的，以评估 DCC 与 ICC 的效果。纳入标准包括胎龄为 24（0）至 31（6）周。排除双胎和母亲滥用药物的婴儿。在出生后 6±2、24±4、48±6 和 108±12 小时进行了系列多普勒研究。测量包括上腔静脉血流、右心室输出、大脑中动脉血流速度（BFV）、肠系膜上动脉 BFV、左心室缩短分数和动脉导管未闭的存在。
25 名婴儿被纳入 DCC 组，26 名婴儿被纳入 ICC 组。胎龄、出生体重和性别相似。入院实验室和临床事件也相似。在研究期间，DCC 导致上腔静脉血流显著增加，48 小时时右心室输出和右心室每搏量也增加。大脑中动脉 BFV、平均肠系膜上动脉 BFV、缩短分数或动脉导管未闭的发生率无差异。
早产儿 DCC 与出生后最初几天可能有益的血液动力学变化有关。
