Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, NB, E3B 5N5, Canada.
Faculty of Science, University of New Brunswick, Fredericton, NB, Canada.
Arch Gynecol Obstet. 2019 Mar;299(3):719-724. doi: 10.1007/s00404-019-05048-5. Epub 2019 Jan 17.
Although delayed umbilical cord clamping has been shown to have significant benefits for both term and preterm infants, currently, data on its impact on blood gas analysis have been scant and conflicting.
In a retrospective review, we compared the demographic characteristics and blood gas parameters of 114 delayed cord clamping (DCC-births between 45 and 90 s in length; 109 being for 60 s) versus 407 early cord clamping births (ECC-immediately after delivery) collected over a 1-year period. Intrapartum care and timing of cord clamping for individual cases were performed at the discretion of obstetricians. The differences were assessed for statistical and clinical significance.
The DCC group was found to have significantly higher mean Apgar scores at both 1 and 5 min (p < 0.05), as well as lower percentages of nulliparous births, cesarean-section deliveries, epidural anesthesia usage, and major pregnancy-related complications. No significant differences in maternal age, gestational age, neonate birthweight, sex, or in the presence of meconium at birth were observed. A higher umbilical artery pO in the DCC group [21 (9) vs. 19 (10) mmHg, p < 0.05] was the only statistically significant difference found out of all the blood gas parameters analyzed.
In this study, infants selected for the DCC procedure were found to be overall lower risk than those delivered as per the standard ECC procedure. No clinically significant difference in any blood gas parameter was observed, and therefore, no adjustment to clinical reference intervals is needed for DCC blood gas samples taken after a 1-min delay period.
尽管延迟脐带夹闭已被证明对足月和早产儿都有显著益处,但目前关于其对血气分析影响的数据仍然很少且相互矛盾。
在一项回顾性研究中,我们比较了 114 例延迟脐带夹闭(DCC-夹闭时间为 45-90 秒;109 例夹闭 60 秒)与 407 例早期脐带夹闭(ECC-分娩后立即夹闭)的人口统计学特征和血气参数。每位产妇的产程护理和脐带夹闭时间均由产科医生根据具体情况决定。评估差异是否具有统计学和临床意义。
DCC 组在 1 分钟和 5 分钟时的平均 Apgar 评分明显更高(p<0.05),且初产妇、剖宫产、硬膜外麻醉使用率和主要妊娠相关并发症的比例较低。产妇年龄、胎龄、新生儿出生体重、性别或出生时胎粪污染无显著差异。DCC 组脐带动脉 pO 更高[21(9)比 19(10)mmHg,p<0.05],这是分析的所有血气参数中唯一具有统计学意义的差异。
在这项研究中,选择行 DCC 操作的婴儿总体上比按标准 ECC 操作分娩的婴儿风险更低。在任何血气参数方面均无临床显著差异,因此,在延迟 1 分钟后采集 DCC 血气样本时,不需要对临床参考区间进行调整。