脐带夹闭时机的比较：一项在 32 周前分娩的随机对照临床试验，随访至产后 1 年。

Cord pilot trial, comparing alternative policies for timing of cord clamping before 32 weeks gestation: follow-up for women up to one year.

机构信息

Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, NG7 2UH, UK.

School of Health Sciences, University of Brighton, Falmer, BN1 9PH, UK.

出版信息

BMC Pregnancy Childbirth. 2019 Feb 21;19(1):78. doi: 10.1186/s12884-019-2223-9.

DOI:10.1186/s12884-019-2223-9

PMID:30791873

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6383279/

Abstract

BACKGROUND

The Cord Pilot Trial compared two alternative policies for cord clamping at very preterm birth at eight UK maternity units: clamping after at least 2 min and immediate neonatal care (if needed) with cord intact, or clamping within 20 s and neonatal care after clamping. This paper reports follow-up of the women by two self-completed questionnaires up to one year after the birth.

METHODS

Women were given or posted the first questionnaire between four and eight weeks after birth, usually before their baby was discharged, and were posted a second similar questionnaire at one year. The questionnaire included the Hospital Anxiety and Depression Scale; the Preterm Birth Experience and Satisfaction Scale (P-BESS) and questions about their baby's feeding.

RESULTS

Of 261 women randomised (132 clamping ≥2 min, 129 clamping ≤20 s), six were excluded as birth was after 35 weeks (2, 4 in each group respectively). Six were not sent either questionnaire. The first questionnaire was given/sent to 244 and returned by 186 (76%) (79, 74%). The second, at one year, was sent to 242 and returned by 133 (55%) (66, 43%). On the first questionnaire, 89 (49%) had a score suggestive of an anxiety disorder, and 55 (30%) had a score suggestive of depression. Satisfaction with care at birth was high: median total P-BESS score 77 [interquartile range 68 to 84] (scale 17 to 85). There was no clear difference in anxiety, depression, or satisfaction with care between the two allocated groups. The median number of weeks after birth women breastfed/expressed was 16 (95% confidence interval (CI) 13 to 20, n = 119) for those allocated clamping ≥2 min and 12 (95% CI 11 to 16, n = 103) for those allocated clamping ≤20 s.

CONCLUSIONS

The response rate was higher for the earlier questionnaire than at one year. A high proportion of women reported symptoms of anxiety or depression, however there were no clear differences between the allocated groups. Most women reported that they had breastfed or expressed milk and those allocated deferred cord clamping reported continuing this for slightly longer.

TRIAL REGISTRATION

ISRCTN 21456601, registered 28th February 2013, http://www.isrctn.com/ISRCTN21456601.

摘要

背景

Cord Pilot 试验比较了在 8 家英国产科单位对非常早产分娩时两种不同的脐带夹闭策略：夹闭时间至少 2 分钟以上，且保持脐带完整以进行新生儿即时护理（如果需要），或在 20 秒内夹闭脐带并在夹闭后进行新生儿护理。本文报告了通过两份自我完成的问卷对分娩后一年的女性进行的随访。

方法

在分娩后 4 至 8 周内，通常在婴儿出院前，将问卷寄给或交给女性，并在一年时寄出第二份类似的问卷。问卷包括医院焦虑和抑郁量表；早产儿分娩体验和满意度量表（P-BESS）和有关婴儿喂养的问题。

结果

261 名随机分配的女性（夹闭时间≥2 分钟 132 名，夹闭时间≤20 秒 129 名）中，有 6 名因分娩发生在 35 周后而被排除（每组各 2 名）。有 6 名女性未收到任何一份问卷。244 名女性收到了第一份问卷，其中 186 名（76%）（79，74%）进行了回复。242 名女性收到了第二年的问卷，其中 133 名（55%）（66，43%）进行了回复。在第一份问卷中，89 名（49%）有焦虑障碍的得分提示，55 名（30%）有抑郁的得分提示。对出生时护理的满意度很高：中位总 P-BESS 评分为 77[四分位距（IQR）68 至 84]（范围 17 至 85）。两组之间的焦虑、抑郁或护理满意度没有明显差异。夹闭时间≥2 分钟组中位产后母乳喂养/挤奶周数为 16（95%置信区间（CI）13 至 20，n=119），夹闭时间≤20 秒组为 12（95%CI 11 至 16，n=103）。