Effects of immediate and delayed cord clamping on infants of 24 to 32 weeks gestational age

2.50
Hdl Handle:
http://hdl.handle.net/10755/163679
Category:
Abstract
Type:
Presentation
Title:
Effects of immediate and delayed cord clamping on infants of 24 to 32 weeks gestational age
Author(s):
Mercer, Judith; McGrath, Margaret; Oh, William; Silver, Helayne; Hensman, Angelita
Author Details:
Judith S. Mercer, DNSc, CNM, University of Rhode Island, Kingston, Rhode Island, USA, email: jmercer@uri.edu; Margaret McGrath; William Oh; Helayne Silver; Angelita Hensman
Abstract:
This study was a randomized controlled unmasked trial to compare the effects of immediate (ICC) and delayed (DCC) cord clamping on infants born between 24 and 32 weeks and to assess the feasibility of the study. Research Questions: The hypotheses were that the infants with DCC would have higher blood pressures, higher hematocrits, less oxygen use and fewer days of ventilation compared to ICC infants. Other variables examined included initial glucose levels, incidence of feeding intolerance during NICU stay, and oxygen use at 36 weeks. Framework: This study's theoretical physiological framework proposes that successful neonatal transition depends on the newborn having adequate blood available to maintain normal systemic perfusion, blood pressure, tissue oxygenation, nutrient delivery, and to recruit the lung for gas exchange. Early cord clamping may deprive the VLBW preterm infant of adequate blood volume. Methods: Immediately before delivery, 32 mother/fetus pairs were randomized to either ICC or DCC groups. DCC babies had cord clamping delayed for 30 to 45 seconds while being lowered as much as the cord length would allow without tension to obtain maximum placental transfusion. ICC babies had cord clamping at 5 to 10 seconds after the delivery of the buttocks. The obstetrician's cooperation was obtained before mothers were approached for consent and enrolled. Results: Cord clamping time as per protocol was significantly longer in the DCC group (35.5 +/- 5 seconds versus 6.2 +/- 3 seconds, p < 0.000). Analyses were completed using the intention-to-treat grouping. There were no significant differences in any maternal variables including age, ethnicity, parity, antenatal steroids given, use of magnesium sulfate, or cesarean section rates. The infant groups were similar in mean birth weights, gestational age, male/female ratio, Apgar scores, temperature on admission to the nursery, and peak serum bilirubin levels. In the first 12 hours of life, significantly higher initial mean blood pressures and initial glucose levels were found in the DCC group (p < 0.05). No infants in the DCC had glucose levels under 40 mg/dl versus 6/16 in the ICC group who were below 40. During the NICU stay, babies with DCC had fewer incidences of suspected necrotizing enterocolitis (p < 0.001) defined as occurring when the neonatologists ordered an x-ray using the diagnosis of rule out NEC. There were also fewer babies in the DCC group on oxygen at 36 weeks (5/16 or 31% versus 9/16 or 56%) although this did not reach statistical significance ( p= 0.15). Conclusions: These findings indicate that the research design is feasible as there were no adverse effects noted from the protocol. The immediate benefit of improved blood pressure as seen in other studies was confirmed. This was the first study to find higher initial glucose levels and less feeding intolerance in infants born at 24 to 32 weeks gestation with delayed cord clamping. Implications. Feeding intolerance is a major concern for the VLBW infant and the nurses caring for him. If significant differences continue to be found in further studies, the health and economic impact of this simple intervention could be impressive.
Repository Posting Date:
27-Oct-2011
Date of Publication:
27-Oct-2011
Conference Date:
2002
Conference Name:
14th Annual Scientific Sessions
Conference Host:
Eastern Nursing Research Society
Conference Location:
University Park, Pennsylvania, USA
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typePresentationen_GB
dc.titleEffects of immediate and delayed cord clamping on infants of 24 to 32 weeks gestational ageen_GB
dc.contributor.authorMercer, Judithen_US
dc.contributor.authorMcGrath, Margareten_US
dc.contributor.authorOh, Williamen_US
dc.contributor.authorSilver, Helayneen_US
dc.contributor.authorHensman, Angelitaen_US
dc.author.detailsJudith S. Mercer, DNSc, CNM, University of Rhode Island, Kingston, Rhode Island, USA, email: jmercer@uri.edu; Margaret McGrath; William Oh; Helayne Silver; Angelita Hensmanen_US
dc.identifier.urihttp://hdl.handle.net/10755/163679-
dc.description.abstractThis study was a randomized controlled unmasked trial to compare the effects of immediate (ICC) and delayed (DCC) cord clamping on infants born between 24 and 32 weeks and to assess the feasibility of the study. Research Questions: The hypotheses were that the infants with DCC would have higher blood pressures, higher hematocrits, less oxygen use and fewer days of ventilation compared to ICC infants. Other variables examined included initial glucose levels, incidence of feeding intolerance during NICU stay, and oxygen use at 36 weeks. Framework: This study's theoretical physiological framework proposes that successful neonatal transition depends on the newborn having adequate blood available to maintain normal systemic perfusion, blood pressure, tissue oxygenation, nutrient delivery, and to recruit the lung for gas exchange. Early cord clamping may deprive the VLBW preterm infant of adequate blood volume. Methods: Immediately before delivery, 32 mother/fetus pairs were randomized to either ICC or DCC groups. DCC babies had cord clamping delayed for 30 to 45 seconds while being lowered as much as the cord length would allow without tension to obtain maximum placental transfusion. ICC babies had cord clamping at 5 to 10 seconds after the delivery of the buttocks. The obstetrician's cooperation was obtained before mothers were approached for consent and enrolled. Results: Cord clamping time as per protocol was significantly longer in the DCC group (35.5 +/- 5 seconds versus 6.2 +/- 3 seconds, p < 0.000). Analyses were completed using the intention-to-treat grouping. There were no significant differences in any maternal variables including age, ethnicity, parity, antenatal steroids given, use of magnesium sulfate, or cesarean section rates. The infant groups were similar in mean birth weights, gestational age, male/female ratio, Apgar scores, temperature on admission to the nursery, and peak serum bilirubin levels. In the first 12 hours of life, significantly higher initial mean blood pressures and initial glucose levels were found in the DCC group (p < 0.05). No infants in the DCC had glucose levels under 40 mg/dl versus 6/16 in the ICC group who were below 40. During the NICU stay, babies with DCC had fewer incidences of suspected necrotizing enterocolitis (p < 0.001) defined as occurring when the neonatologists ordered an x-ray using the diagnosis of rule out NEC. There were also fewer babies in the DCC group on oxygen at 36 weeks (5/16 or 31% versus 9/16 or 56%) although this did not reach statistical significance ( p= 0.15). Conclusions: These findings indicate that the research design is feasible as there were no adverse effects noted from the protocol. The immediate benefit of improved blood pressure as seen in other studies was confirmed. This was the first study to find higher initial glucose levels and less feeding intolerance in infants born at 24 to 32 weeks gestation with delayed cord clamping. Implications. Feeding intolerance is a major concern for the VLBW infant and the nurses caring for him. If significant differences continue to be found in further studies, the health and economic impact of this simple intervention could be impressive.en_GB
dc.date.available2011-10-27T11:11:53Z-
dc.date.issued2011-10-27en_GB
dc.date.accessioned2011-10-27T11:11:53Z-
dc.conference.date2002en_US
dc.conference.name14th Annual Scientific Sessionsen_US
dc.conference.hostEastern Nursing Research Societyen_US
dc.conference.locationUniversity Park, Pennsylvania, USAen_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item. If a citation is listed in this record, the item has been published and is available via open-access avenues or a journal/database subscription. Contact your library for assistance in obtaining the as-published article.-
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