延迟结扎脐带并结合挤奶与不结合挤奶对早产儿的影响：一项随机对照试验。
Premature infants receiving delayed cord clamping with and without cord milking: a randomized control trial.
机构信息
Department of Pediatrics, Faculty of Medicine, Thammasat University, Pathumthani, 12120, Thailand.
Department of Obstetrics and Gynaecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand.
出版信息
BMC Pediatr. 2023 Mar 18;23(1):123. doi: 10.1186/s12887-023-03933-2.
BACKGROUND
Preterm infants often have long hospital stays and frequent blood tests; they often develop anemia requiring multiple blood transfusions. Placental transfusion via delayed cord clamping (DCC) or umbilical cord milking (UCM) helps increase blood volume. We hypothesized umbilical cord milking (UCM), together with DCC, would be superior in reducing blood transfusions.
OBJECTIVES
To compare the effects of DCC and DCC combined with UCM on hematologic outcomes among preterm infants.
METHODS
One hundred twenty singleton preterm infants born at 280/7- 336/7 weeks of gestation at Thammasat University Hospital were enrolled in an open-label, randomized, controlled trial. They were placed into three groups (1:1:1) by a block-of-three randomization: DCC for 45 s, DCC with UCM performed before clamping (DCM-B), and DCC with UCM performed after clamping (DCM-A). The primary outcomes were hematocrit levels and number of infants receiving blood transfusions during the first 28 days of life. Intraventricular hemorrhage (IVH) and necrotizing enterocolitis (NEC) were secondary outcomes. Analyses were performed with an intent-to-treat approach.
RESULTS
One hundred twenty preterm infants were randomized. There was no statistically significant difference in neonatal outcomes; hematocrit on admission 54.0 ± 5.5, 53.3 ± 6.0, and 54.3 ± 5.8 (p = 0.88), receiving blood transfusions 25%, 20%, and 12.5% (p = 0.24), incidence of NEC 7.5, 0 and 10% (p = 0.78) in the DCC, DCM-B and DCM-A groups, respectively. There were no preterm infants with severe IVH, polycythemia, maternal or neonatal death.
CONCLUSION
The placental transfusion techniques utilized, DCC and DCC combined with UCM, provided the same benefits for preterm infants born at GA 28 and 33 weeks in terms of reducing the need for RBC transfusions, severities of IVH and incidence of NEC without increasing comorbidity.
TRIAL REGISTRATION
TCTR20190131002 . Registered 31 January 2019-Retrospectively registered.
背景
早产儿通常需要长时间住院和频繁的血液检查；他们经常因贫血而需要多次输血。通过延迟脐带夹闭（DCC）或脐带挤奶（UCM）进行胎盘输血有助于增加血容量。我们假设脐带挤奶（UCM）与 DCC 结合使用在减少输血方面会更有效。
目的
比较 DCC 和 DCC 联合 UCM 对早产儿血液学结局的影响。
方法
120 名在泰国法政大学医院出生胎龄为 280/7-336/7 周的单胎早产儿被纳入一项开放性、随机、对照临床试验。他们通过三阶段随机分组（1:1:1）分为三组：DCC 45 秒、DCC 联合夹闭前 UCM（DCM-B）和 DCC 联合夹闭后 UCM（DCM-A）。主要结局是出生后第 28 天内的血细胞比容水平和需要输血的婴儿数量。颅内出血（IVH）和坏死性小肠结肠炎（NEC）为次要结局。采用意向治疗方法进行分析。
结果
120 名早产儿被随机分配。新生儿结局无统计学差异；入院时血细胞比容分别为 54.0±5.5、53.3±6.0 和 54.3±5.8（p=0.88），需要输血的比例分别为 25%、20%和 12.5%（p=0.24），NEC 的发生率分别为 7.5%、0%和 10%（p=0.78），DCC、DCM-B 和 DCM-A 组分别为 7.5%、0%和 10%。没有早产儿发生严重 IVH、红细胞增多症、产妇或新生儿死亡。
结论
对于胎龄为 28 周和 33 周的早产儿，DCC 和 DCC 联合 UCM 等胎盘输血技术在减少 RBC 输血需求、IVH 严重程度和 NEC 发生率方面提供了相同的益处，同时没有增加并发症。
试验注册
TCTR20190131002。2019 年 1 月 31 日注册-回顾性注册。
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