Ghirardello Stefano, Crippa Beatrice L, Cortesi Valeria, Di Francesco Elena, Consonni Dario, Colombo Lorenzo, Fumagalli Monica, Te Pas Arjan B, Mosca Fabio
Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Front Pediatr. 2018 Sep 19;6:241. doi: 10.3389/fped.2018.00241. eCollection 2018.
To compare the effect of Delayed Cord Clamping (DCC) to Immediate Cord Clamping (ICC) on phototherapy treatment in a cohort of cesarean-delivered newborns with AB0-alloimmunization. In a retrospective cohort study neonates with Gestational Age (GA) ≥ 35 weeks and diagnosed with AB0-alloimmunization before implementation of DCC (ICC group) were compared with neonates born after implementation (DCC group). The primary outcome was the need for phototherapy. Secondary outcomes included hospital stay, readmission rate, need for extra intravenous fluids, maximum bilirubin concentration, and hours of life at bilirubin peak. We used regression models to adjust for weight loss, type of feeding, birth weight, and gestational age. In total 336 neonates were included, of which 192 neonates in the ICC group and 144 in the DCC group. There were no differences in basic characteristics between the two groups except for birth weight (ICC 3193 ± 468 g vs. DCC 3053 ± 446 g, = 0.01) and GA (ICC 38.2 ± 1 weeks of GA, vs. DCC 37.9 ± 1 weeks of GA; = 0.01). When adjusted for confounding factors, after implementation of DCC, significantly more infants with AB0 alloimmunization needed phototherapy (22.4% vs. 36.8%, RR 1.61 CI: 1.15-2.28; = 0.006; Number Needed to Harm 7), needed to stay longer in hospital (20.3% vs. 30.5%, RR 1.53 CI: 1.05-2.23; = 0.03). The maximum bilirubin was higher (11.4 ± 4.0 mg/dl vs. 12.9 ± 3.5 mg/dl, < 0.001) and occurred later [74 (67-92) hours vs. 84 (70-103) hours; = 0.04]. There was no difference in the need for intravenous fluids (1.6% vs. 4.9%; not significant) and readmissions (1.6% vs. 3.5%; not significant). Infants with AB0 alloimmunization needed more often phototherapy and were admitted longer after implementation of DCC policy. Further studies are needed to see whether the benefit of DCC outweighs the increased morbidity, admission days, and related hospital costs.
比较延迟脐带结扎（DCC）与立即脐带结扎（ICC）对一组剖宫产分娩的ABO血型不合新生儿光疗治疗的影响。在一项回顾性队列研究中，将孕周（GA）≥35周且在实施DCC之前被诊断为ABO血型不合的新生儿（ICC组）与实施之后出生的新生儿（DCC组）进行比较。主要结局是光疗需求。次要结局包括住院时间、再入院率、额外静脉补液需求、最高胆红素浓度以及胆红素峰值时的出生小时数。我们使用回归模型对体重减轻、喂养方式、出生体重和孕周进行校正。总共纳入336例新生儿，其中ICC组192例，DCC组144例。除出生体重（ICC 3193±468 g vs. DCC 3053±446 g，P = 0.01）和孕周（ICC 38.2±1孕周，vs. DCC 37.9±1孕周；P = 0.01）外，两组间基本特征无差异。校正混杂因素后，实施DCC后，ABO血型不合的婴儿需要光疗的比例显著更高（22.4% vs. 36.8%，RR 1.61 CI：1.15 - 2.28；P = 0.006；伤害所需人数7），住院时间更长（20.3% vs. 30.5%，RR 1.53 CI：1.05 - 2.23；P = 0.03）。最高胆红素水平更高（11.4±4.0 mg/dl vs. 12.9±3.5 mg/dl，P < 0.001）且出现时间更晚[74（67 - 92）小时 vs. 84（70 - 103）小时；P = 0.04]。静脉补液需求（1.6% vs. 4.9%；无显著性差异）和再入院率（1.6% vs. 3.5%；无显著性差异）无差异。ABO血型不合的婴儿在实施DCC政策后更常需要光疗且住院时间更长。需要进一步研究以确定DCC的益处是否超过发病率增加、住院天数增加及相关医院费用。
