健康足月新生儿延迟断脐：弊大于利还是利大于弊？

Delayed cord clamping in healthy term infants: More harm or good?

机构信息

Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.

Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA, United States.

出版信息

Semin Fetal Neonatal Med. 2021 Apr;26(2):101221. doi: 10.1016/j.siny.2021.101221. Epub 2021 Feb 24.

DOI:10.1016/j.siny.2021.101221

PMID:33653601

Abstract

It is recommended to delay cord clamping in healthy term infants for at least 60- and 180-s in high- and limited-resource environments, as delayed cord clamping lowers the incidence of anemia and iron deficiency and improves neurodevelopment. There are improvements in hemodynamic parameters such as peripheral arterial oxygen saturation, heart rate, cardiac output, and cerebral oxygenation. Historically, delayed cord clamping caused a higher rate of hyperbilirubinemia and phototherapy, but more recent evidence suggests this may no longer be the case. In limited-resource environments delayed cord clamping may reduce anemia and iron deficiency potentially improving neurodevelopmental outcomes. The use of delayed cord clamping in newborn infants with intrauterine growth restriction or monochorionic twins is limited and further evidence is needed before it can be formally recommended.

摘要

建议在健康足月婴儿中至少延迟 60-180 秒夹闭脐带，无论是在高资源环境还是有限资源环境中，因为延迟夹闭脐带可以降低贫血和缺铁的发生率，并改善神经发育。在血液动力学参数方面也有改善，如外周动脉血氧饱和度、心率、心输出量和脑氧合。从历史上看，延迟夹闭脐带会导致更高的胆红素血症和光疗发生率，但最近的证据表明，这种情况可能不再如此。在有限资源环境中，延迟夹闭脐带可能会减少贫血和缺铁，从而潜在地改善神经发育结局。延迟夹闭脐带在宫内生长受限或单绒毛膜双胎新生儿中的应用有限，需要更多证据才能正式推荐。