Le Duc Kévin, Mur Sébastien, Rakza Thameur, Boukhris Mohamed Riadh, Rousset Céline, Vaast Pascal, Westlynk Nathalie, Aubry Estelle, Sharma Dyuti, Storme Laurent
ULR2694 Metrics‑Perinatal Environment and Health, University of Lille, 59000 Lille, France.
Department of Neonatology, Jeanne de Flandre Hospital, Centre Hospitalier Universitaire de Lille, 59000 Lille, France.
Children (Basel). 2021 Apr 26;8(5):339. doi: 10.3390/children8050339.
Resuscitation at birth of infants with Congenital Diaphragmatic Hernia (CDH) remains highly challenging because of severe failure of cardiorespiratory adaptation at birth. Usually, the umbilical cord is clamped immediately after birth. Delaying cord clamping while the resuscitation maneuvers are started may: (1) facilitate blood transfer from placenta to baby to augment circulatory blood volume; (2) avoid loss of venous return and decrease in left ventricle filling caused by immediate cord clamping; (3) prevent initial hypoxemia because of sustained uteroplacental gas exchange after birth when the cord is intact. The aim of this trial is to evaluate the efficacy of intact cord resuscitation compared to immediate cord clamping on cardiorespiratory adaptation at birth in infants with isolated CDH. The Congenital Hernia Intact Cord (CHIC) trial is a prospective multicenter open-label randomized controlled trial in two balanced parallel groups. Participants are randomized either immediate cord clamping (the cord will be clamped within the first 15 s after birth) or to intact cord resuscitation group (umbilical cord will be kept intact during the first part of the resuscitation). The primary end-point is the number of infants with APGAR score <4 at 1 min or <7 at 5 min. One hundred eighty participants are expected for this trial. To our knowledge, CHIC is the first study randomized controlled trial evaluating intact cord resuscitation on newborn infant with congenital diaphragmatic hernia. Better cardiorespiratory adaptation is expected when the resuscitation maneuvers are started while the cord is still connected to the placenta.
先天性膈疝（CDH）患儿出生时的复苏仍然极具挑战性，因为出生时心肺适应严重失败。通常，婴儿出生后立即夹紧脐带。在开始复苏操作时延迟夹紧脐带可能：（1）促进血液从胎盘转移到婴儿，以增加循环血容量；（2）避免静脉回流丧失以及因立即夹紧脐带导致左心室充盈减少；（3）在出生后脐带完整时，由于子宫胎盘持续气体交换，防止初始低氧血症。本试验的目的是评估与立即夹紧脐带相比，完整脐带复苏对孤立性CDH婴儿出生时心肺适应的疗效。先天性疝完整脐带（CHIC）试验是一项前瞻性多中心开放标签随机对照试验，分为两个平衡的平行组。参与者被随机分为立即夹紧脐带组（脐带将在出生后15秒内夹紧）或完整脐带复苏组（在复苏的第一阶段脐带将保持完整）。主要终点是1分钟时APGAR评分<4或5分钟时<7的婴儿数量。预计该试验有180名参与者。据我们所知，CHIC是第一项评估对先天性膈疝新生儿进行完整脐带复苏的随机对照试验。当复苏操作在脐带仍与胎盘相连时开始时，预计会有更好的心肺适应。
