Division of Neonatology, Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA.
Division of Neonatology, Neonatal Research Institute, Sharp Mary Birch Hospital for Women & Newborns, San Diego, CA; Department of Obstetrics, University of Rhode Island, Kingston, RI.
J Pediatr. 2023 Jun;257:113383. doi: 10.1016/j.jpeds.2023.03.001. Epub 2023 Mar 11.
To assess the hemodynamic safety and efficacy of umbilical cord milking (UCM) compared with early cord clamping (ECC) in nonvigorous newborn infants enrolled in a large multicenter randomized cluster-crossover trial.
Two hundred twenty-seven nonvigorous term or near-term infants who were enrolled in the parent UCM vs ECC trial consented for this substudy. An echocardiogram was performed at 12 ± 6 hours of age by ultrasound technicians blinded to randomization. The primary outcome was left ventricular output (LVO). Prespecified secondary outcomes included measured superior vena cava (SVC) flow, right ventricular output (RVO), peak systolic strain, and peak systolic velocity by tissue Doppler examination of the RV lateral wall and the interventricular septum.
Nonvigorous infants receiving UCM had increased hemodynamic echocardiographic parameters as measured by higher LVO (225 ± 64 vs 187 ± 52 mL/kg/min; P < .001), RVO (284 ± 88 vs 222 ± 96 mL/kg/min; P < .001), and SVC flow (100 ± 36 vs 86 ± 40 mL/kg/min; P < .001) compared with the ECC group. Peak systolic strain was lower (-17 ± 3 vs -22 ± 3%; P < .001), but there was no difference in peak tissue Doppler flow (0.06 m/s [IQR, 0.05-0.07 m/s] vs 0.06 m/s [IQR, 0.05-0.08 m/s]).
UCM increased cardiac output (as measured by LVO) compared with ECC in nonvigorous newborns. Overall increases in measures of cerebral and pulmonary blood flow (as measured by SVC and RVO flow, respectively) may explain improved outcomes associated with UCM (less cardiorespiratory support at birth and fewer cases of moderate-to-severe hypoxic ischemic encephalopathy) among nonvigorous newborn infants.
在一项大型多中心随机群组交叉试验中，评估与早期脐带夹闭（ECC）相比，脐带挤奶（UCM）对非活力新生儿的血流动力学安全性和疗效。
227 名非活力足月或近足月婴儿参加了 UCM 与 ECC 试验的父母同意参加这项子研究。在 12±6 小时龄时，由对随机分组不知情的超声技师进行超声心动图检查。主要结局是左心室输出量（LVO）。预设的次要结局包括测量上腔静脉（SVC）流量、右心室输出量（RVO）、组织多普勒检查右室侧壁和室间隔的峰值收缩应变和峰值收缩速度。
接受 UCM 的非活力婴儿的血流动力学超声心动图参数较高，表现为 LVO（225±64 比 187±52 mL/kg/min；P<0.001）、RVO（284±88 比 222±96 mL/kg/min；P<0.001）和 SVC 流量（100±36 比 86±40 mL/kg/min；P<0.001）高于 ECC 组。峰值收缩应变较低（-17±3 比-22±3%；P<0.001），但峰值组织多普勒流量无差异（0.06 m/s [IQR，0.05-0.08 m/s] 比 0.06 m/s [IQR，0.05-0.08 m/s]）。
UCM 与 ECC 相比，非活力新生儿的心输出量（以 LVO 测量）增加。脑和肺血流（分别以 SVC 和 RVO 流量测量）的总体增加可能解释了 UCM 与非活力新生儿相关的改善结局（出生时减少心肺支持，较少出现中重度缺氧缺血性脑病）。
