Backes C H, Rivera B, Haque U, Copeland K, Hutchon D, Smith C V
Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA The Heart Center, Nationwide Children's Hospital, Columbus, OH, USA Departments of Pediatrics & Obstetrics and Gynecology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Center for Perinatal Research, Nationwide Children's Hospital, Columbus, OH, USA.
J Neonatal Perinatal Med. 2014;7(4):257-67. doi: 10.3233/NPM-14814034.
Evidence is growing on the potential value of enhancing placental-fetal transfusion at birth, with recent endorsement of the practice by the World Health Organization and American College of Gynecologists. However, these recommendations provide clinicians with little guidance on the optimal practice among infants born extremely premature (<28 weeks gestation) and those requiring immediate resuscitation. The goals of this review are to: 1) provide rationale for better outcomes among extremely preterm infants following delayed cord clamping or umbilical cord "milking" than with immediate cord clamping; 2) describe clinical situations that warrant immediate cord clamping following delivery and explore the controversy regarding optimal cord clamping practice among extremely premature infants, including those requiring immediate resuscitation; 3) discuss the quality of evidence in this subgroup of infants; 4) consider areas for future research, with a focus on characterizing if placental-fetal transfusion affects the magnitude or timing of variables associated with physiological transition. The review provided herein suggests that delayed cord clamping or umbilical cord milking can be applied safely to infants born prior to 28 weeks gestation, but the lack of evidence on the best practice among infants born severely depressed and requiring immediate resuscitation, who comprise a greater proportion of infant deliveries at the lowest gestational ages, is recognized. Future studies using well-defined physiologic outcome measures are needed to understand the role of placental transfusion in premature infants' adaptations to extrauterine life.
越来越多的证据表明出生时增强胎盘 - 胎儿输血具有潜在价值，世界卫生组织和美国妇产科医师学会最近都认可了这种做法。然而，这些建议对于孕周极短（<28周）出生的婴儿以及需要立即复苏的婴儿的最佳操作几乎没有提供指导。本综述的目的是：1）阐述延迟脐带结扎或脐带“挤奶”相比于立即脐带结扎，能使极早产儿获得更好预后的理论依据；2）描述分娩后需要立即脐带结扎的临床情况，并探讨孕周极短的婴儿（包括需要立即复苏的婴儿）在最佳脐带结扎操作方面的争议；3）讨论该亚组婴儿的证据质量；4）考虑未来的研究领域，重点是确定胎盘 - 胎儿输血是否会影响与生理过渡相关变量的程度或时间。本文提供的综述表明，延迟脐带结扎或脐带挤奶可以安全地应用于孕周小于28周出生的婴儿，但对于出生时严重窒息且需要立即复苏的婴儿（在最低孕周的婴儿分娩中占比更大），缺乏关于最佳操作的证据是公认的。需要采用明确的生理结局指标进行未来研究，以了解胎盘输血在早产儿宫外生活适应中的作用。
