Department of Women and Infants, Baylor Scott & White Medical Center McKinney, Pediatrix Medical Group of Dallas, Dallas, Texas.
Department of Medical Education, College of Medicine, Texas A&M University, Bryan, Texas.
Am J Perinatol. 2022 Dec;39(16):1812-1819. doi: 10.1055/s-0041-1726387. Epub 2021 Mar 15.
Well-appearing late preterm infants admitted to a mother baby unit may benefit from either delayed cord clamping (DCC) or umbilical cord milking (UCM). However, there are concerns of adverse effects of increased blood volume such as polycythemia and hyperbilirubinemia. The purpose of this study is to examine the short-term effects of placental transfusion on late preterm infants born between 35 and 36 weeks of gestation.
In this pre- and postimplementation retrospective cohort study, we compared late preterm infants who received placental transfusion (161 infants, DCC/UCM group) during a 2-year period after guideline implementation (postimplementation period: August 1, 2017, to July 31, 2019) to infants who had immediate cord clamping (118 infants, ICC group) born during a 2-year period before implementation (preimplementation period: August 1, 2015, to July 31, 2017).
The mean hematocrit after birth was significantly higher in the DCC/UCM group. Fewer infants had a hematocrit <40% after birth in the DCC/UCM group compared with the ICC group. The incidence of hyperbilirubinemia needing phototherapy, neonatal intensive care unit (NICU) admissions, or readmissions to the hospital for phototherapy was similar between the groups. Fewer infants in the DCC/UCM group were admitted to the NICU primarily for respiratory distress. Symptomatic polycythemia did not occur in either group. Median hospital length of stay was 3 days for both groups.
Placental transfusion (DCC or UCM) in late preterm infants admitted to a mother baby unit was not associated with increased incidence of hyperbilirubinemia needing phototherapy, symptomatic polycythemia, NICU admissions, or readmissions to the hospital for phototherapy.
· Placental transfusion was feasible in late preterm infants.. · Placental transfusion resulted in higher mean hematocrit after birth.. · Placental transfusion did not increase the need for phototherapy.. · Fewer admissions to the NICU for respiratory distress were noted in the placental transfusion group..
外观良好的晚期早产儿入住母婴病房时，可能受益于延迟脐带夹闭（DCC）或脐带挤奶（UCM）。然而，人们担心增加血容量会带来不良影响，如红细胞增多症和高胆红素血症。本研究的目的是检查胎盘输血对胎龄 35 至 36 周之间出生的晚期早产儿的短期影响。
在这项前瞻性和回顾性队列研究中，我们比较了在指南实施后 2 年期间接受胎盘输血的晚期早产儿（161 例，DCC/UCM 组）与在实施前 2 年期间出生的立即脐带夹闭的早产儿（118 例，ICC 组）。
出生后 DCC/UCM 组的平均血细胞比容显著升高。与 ICC 组相比，DCC/UCM 组出生后血细胞比容<40%的婴儿更少。两组间需要光疗、新生儿重症监护病房（NICU）入院或因光疗再次入院的高胆红素血症发生率相似。DCC/UCM 组中因呼吸窘迫而首次入住 NICU 的婴儿较少。两组均未发生症状性红细胞增多症。两组的中位住院时间均为 3 天。
晚期早产儿入住母婴病房时进行胎盘输血（DCC 或 UCM）与需要光疗的高胆红素血症、症状性红细胞增多症、NICU 入院或因光疗再次入院的发生率增加无关。
· 晚期早产儿进行胎盘输血是可行的。· 胎盘输血后出生后的平均血细胞比容升高。· 胎盘输血并未增加光疗的需求。· 接受胎盘输血的婴儿因呼吸窘迫而入住 NICU 的情况较少。
