Jegatheesan Priya, Han Gloria, Narasimhan Sudha Rani, Nudelman Matthew, Jelks Andrea, Song Dongli
Division of Neonatology, Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, CA 95128, USA.
Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA.
Children (Basel). 2025 Aug 29;12(9):1151. doi: 10.3390/children12091151.
Deferred cord clamping (DCC) is beneficial for preterm infants, but there are concerns about the safety of DCC during Cesarean deliveries (CD) under general anesthesia (GA). We evaluated maternal and neonatal outcomes in preterm CD under GA vs. regional anesthesia (RA) after implementing 180 s of DCC.
This retrospective single-center observational study included CD at <33 weeks gestation, delivered between January 2018 and December 2023. The cord was clamped before 180 s for concerns of maternal bleeding or infant apnea after 30-45 s stimulation. Data was collected from reports from electronic medical records, neonatal intensive care unit database, and manually from the medical records of the patient. Multivariable regression analysis was used to assess the effect of anesthesia type and DCC on outcomes, adjusting for confounders.
This study included 170 mothers and 194 infants, and 84.9% of the infants received DCC ≥ 60 s. The GA group had a higher percentage of emergency CD and a lower median duration of DCC (105 s vs. 180 s, ≤ 0.001) compared to RA. In multivariate regression analysis, GA was associated with lower odds (95% CI) of umbilical artery pH < 7 [0.1, (0.0, 0.6)], base deficit ≥ 16 [0.0, (0.0, 0.5)], and higher odds of necrotizing enterocolitis [28.2, (1.4, 560.0)]. GA was not associated with maternal hemorrhage, delivery room (DR) resuscitation, or other major neonatal morbidities or mortality. DCC ≥ 60 s was associated with lower maternal blood loss [Regression coefficient -698, (-1193, -202)], lower odds of transfusion [0.4, (0.1, 1.0)], DR resuscitation [0.4, (0.2, 0.8)], and chronic lung disease [0.4, (0.2, 0.9)], and higher survival without major morbidities [2.8, (1.2, 6.8)].
DCC was performed in a majority of CD under GA by adhering to protocols to shorten DCC in cases where maternal or fetal safety was threatened. GA with DCC was not associated with increased neonatal resuscitation or major neonatal morbidities and was associated with lower maternal hemorrhage and transfusion.
延迟脐带结扎（DCC）对早产儿有益，但人们担心在全身麻醉（GA）下剖宫产（CD）时进行DCC的安全性。我们评估了在实施180秒DCC后，GA与区域麻醉（RA）下早产CD的母婴结局。
这项回顾性单中心观察性研究纳入了2018年1月至2023年12月期间孕周<33周的剖宫产。由于担心母体出血或在30 - 45秒刺激后婴儿呼吸暂停，在180秒之前结扎脐带。数据从电子病历报告、新生儿重症监护病房数据库收集，并手动从患者病历中获取。使用多变量回归分析评估麻醉类型和DCC对结局的影响，并对混杂因素进行调整。
本研究纳入了170名母亲和194名婴儿，84.9%的婴儿接受DCC≥60秒。与RA组相比，GA组急诊剖宫产的比例更高，DCC的中位持续时间更短（105秒对180秒，P≤0.001）。在多变量回归分析中，GA与脐动脉pH<7 [0.1，（0.0，0.6）]、碱缺失≥16 [0.0，（0.0，0.5）]的较低几率相关，与坏死性小肠结肠炎的较高几率相关[28.2，（1.4，560.0）]。GA与母体出血、产房（DR）复苏或其他主要新生儿疾病或死亡率无关。DCC≥60秒与较低的母体失血量[回归系数 - 698，（- 1193，- 202）]、输血几率较低[0.4，（0.1，1.0）]、DR复苏几率较低[0.4，（0.2，0.）]和慢性肺病几率较低[0.4，（0.2，0.9）]以及无主要疾病的较高存活率[2.8，（1.2，6.8）]相关。
在大多数GA下的剖宫产中，通过遵守方案在母体或胎儿安全受到威胁的情况下缩短DCC来实施DCC。GA联合DCC与新生儿复苏增加或主要新生儿疾病无关，且与较低的母体出血和输血相关。
