Fenton Christen, McNinch Neil L, Bieda Amy, Dowling Donna, Damato Elizabeth
Rebecca Considine Research Institute (Mr McNinch), Akron Children's Hospital (Dr Fenton), Akron, Ohio; Frances Payne Bolton School of Nursing (Drs Bieda, Dowling, and Damato), and Department of Neurosciences, School of Medicine (Dr Damato), Case Western Reserve University, Cleveland, Ohio.
Adv Neonatal Care. 2018 Jun;18(3):223-231. doi: 10.1097/ANC.0000000000000492.
Evidence supports a significant reduction in the incidence of intraventricular hemorrhage (IVH) in preterm infants receiving delayed umbilical cord clamping (DCC).
This study evaluated clinical feasibility, efficacy, and safety outcomes in preterm infants (<36 weeks' gestational age) who received DCC following a practice change implementation intended to reduce the incidence of IVH.
Infants receiving DCC (45-60 seconds) were compared with a sample of infants receiving immediate umbilical cord clamping (<15 seconds) in a retrospective chart review (N = 354). The primary outcome measure was the prevalence of IVH. Secondary safety outcome measures of 1- and 5-minute Apgar scores, axillary temperature on neonatal intensive care unit admission, and initial 24-hour bilirubin level were also evaluated. Gestational age was examined for its effect on outcomes.
Although the small number of infants with IVH precluded the ability to detect statistical significance, our raw data suggest DCC is efficacious in reducing the risk for IVH. For infants 29 or less weeks' gestational age, admission axillary temperature was significantly higher in those who received DCC. No differences were found in 1- and 5-minute Apgar scores, 24-hour bilirubin level, or hematocrit level between the two groups. Infants more than 29 weeks' gestational age who received DCC had significantly higher 1-minute Apgar scores, temperature, and 24-hour bilirubin level.
Clinicians should advocate for the implementation of DCC as part of the resuscitative process for preterm neonates.
Future studies are needed to evaluate the effect of DCC on other clinical outcomes and to investigate umbilical cord milking as an alternative approach to DCC.
有证据表明，接受延迟脐带结扎（DCC）的早产儿脑室内出血（IVH）发生率显著降低。
本研究评估了在实施旨在降低IVH发生率的实践变革后，接受DCC的孕周小于36周的早产儿的临床可行性、疗效和安全性结局。
在一项回顾性病历审查中（N = 354），将接受DCC（45 - 60秒）的婴儿与接受即刻脐带结扎（<15秒）的婴儿样本进行比较。主要结局指标是IVH的患病率。还评估了1分钟和5分钟阿氏评分、新生儿重症监护病房入院时的腋温以及初始24小时胆红素水平等次要安全性结局指标。研究了孕周对结局的影响。
尽管IVH婴儿数量较少，无法检测到统计学显著性，但我们的原始数据表明DCC在降低IVH风险方面是有效的。对于孕周小于或等于29周的婴儿，接受DCC的婴儿入院时腋温显著更高。两组在1分钟和5分钟阿氏评分、24小时胆红素水平或血细胞比容水平方面未发现差异。孕周大于29周且接受DCC的婴儿1分钟阿氏评分、体温和24小时胆红素水平显著更高。
临床医生应倡导将DCC作为早产儿复苏过程的一部分加以实施。
未来需要开展研究，以评估DCC对其他临床结局的影响，并研究脐带挤血作为DCC的替代方法。
