Bennett Carrie, Munoz Jessian L, Yao Meng, Singh Katherine
Obstetrics, Gynecology and Women's Health Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Obstetrics & Gynecology, Division of Maternal Fetal Medicine, University of Texas Health San Antonio, San Antonio, TX, USA.
J Matern Fetal Neonatal Med. 2022 Dec;35(25):7267-7275. doi: 10.1080/14767058.2021.1946785. Epub 2021 Jul 29.
To evaluate the effects of delayed cord clamping on neonatal hyperbilirubinemia in infants born to patients diagnosed with pre-gestational diabetes (type I or type II).
In January 2016, our institution implemented an organization-wide thirty-second delayed cord clamping protocol. This retrospective cross-sectional study represents infants of mothers diagnosed with pre-gestational diabetes who delivered before and after protocol implementation. The study period was from October 2014 to August 2017. The primary outcome was peak neonatal transcutaneous bilirubin (mg/dL) level during neonatal hospital stay. The secondary outcomes included neonatal serum bilirubin (mg/dL), jaundice requiring phototherapy, hypoglycemia, polycythemia, respiratory distress, and neonatal intensive care unit (NICU) admission. A subgroup analysis for outcomes stratified by type of pre-gestational diabetes was also performed.
145 patients were included in the final analysis. The mean peak neonatal transcutaneous bilirubin level was 10.1 mg/dL ± 3.4 mg/dL for immediate cord clamping and 9.5 mg/dL ± 3.4 mg/dL for delayed cord clamping ( = .25). There were no significant differences between groups for neonatal jaundice requiring phototherapy, hypoglycemia, polycythemia, respiratory distress, or NICU admission. No differences were observed in neonatal outcome by subgroup analysis of pre-gestational diabetes type.
In our study, there was no significant increase in peak neonatal transcutaneous bilirubin in term (≥37 week) infants of mothers with pre-gestational diabetes after undergoing thirty-seconds of delayed cord clamping. In the absence of contraindications, we advocate for continued use of delayed cord clamping for these infants.
评估延迟脐带结扎对孕前糖尿病（I型或II型）患者所分娩婴儿新生儿高胆红素血症的影响。
2016年1月，我们机构实施了一项全机构范围内的30秒延迟脐带结扎方案。这项回顾性横断面研究纳入了在方案实施前后分娩的、被诊断为孕前糖尿病母亲的婴儿。研究时间段为2014年10月至2017年8月。主要结局是新生儿住院期间经皮胆红素峰值（mg/dL）水平。次要结局包括新生儿血清胆红素（mg/dL）、需要光疗的黄疸、低血糖、红细胞增多症、呼吸窘迫以及新生儿重症监护病房（NICU）收治情况。还对按孕前糖尿病类型分层的结局进行了亚组分析。
145例患者纳入最终分析。即刻脐带结扎组新生儿经皮胆红素峰值平均水平为10.1mg/dL±3.4mg/dL，延迟脐带结扎组为9.5mg/dL±3.4mg/dL（P = 0.25）。两组在需要光疗的新生儿黄疸、低血糖、红细胞增多症、呼吸窘迫或NICU收治方面无显著差异。按孕前糖尿病类型进行亚组分析时，未观察到新生儿结局有差异。
在我们的研究中，孕前糖尿病母亲的足月（≥37周）婴儿在经历30秒延迟脐带结扎后，新生儿经皮胆红素峰值无显著升高。在没有禁忌证的情况下，我们主张对这些婴儿继续采用延迟脐带结扎。
