Objective To investigate the effect of different ways of umbilical cord milking(UCM) on the hemoglobin level and complication incidences in very preterm infants, so as to provide reference for choosing appropriate way of UCM in clinic. Methods From May 2018 to May 2021,a total of 262 cases of very preterm infants delivered via vagina in Zhongshan Hospital Affiliated to Xiamen University with gestational age of 28 to 31+6 weeks were divided into intact umbilical cord milking(I-UCM) group(n=87), cut-umbilical cord milking(C-UCM) group(n=88), immediate cord milking(ICC) group(n=87) according to different umbilical cord clamping methods. The hemoglobin level, hematocrit, serum total bilirubin level, phototherapy rate and transfusion rate during hospitalization of very preterm infants were compared among three groups. Besides, peri/intraventricular hemorrhage, neonatal necrotizing enterocolitis(NEC), retinopathy of prematurity(ROP), bronchopulmonary dysplasia(BPD), neonatal hypoglycemia and neonatal hypothermia were also compared among three groups. Results The levels of hemoglobin and hematocritin 1 hour after birth in I-UCM group and C-UCM group were significantly higher than those in ICC group(F=26.754, 29.147, P＜0.001), which were even higher in I-UCM group than C-UCM group(P<0.001). Serum total bilirubin level in the third and fifth day after birth in both groups of I-UCM and C-UCM were higher than those in group ICC(F=4.319,7.117, P=0.014). The incidence rates of peri/intraventricular hemorrhage(χ2=10.261), NEC(χ2=6.512), hypoglycemia and hypothermia(χ2=13.198) in both I-UCM group and C-UCM group were significantly lower than those in ICC group(P<0.05). There were no significant differences in the incidence rates of ROP, BPD and the proportion of phototherapyduring hospitalization in very preterm among the three groups(P>0.05). Conclusions Both I-UCM and C-UCM can effectively increase the blood volume of very preterm infants. The two UCM methods have similar effects on reducing the incidence of peri/ventricular hemorrhage, NEC, neonatal hypoglycemia, neonatal hypothermia and blood transfusion rate of very preterm infants.
Key words
umbilical cord milking /
hemoglobin /
very preterm infants
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Khasawneh W, Khriesat W. Assessment and comparison of mortality and short-term outcomes among premature infants before and after 32-week gestation: A cross-sectional analysis[J]. Ann Med Surg (Lond),2020, 60:44-49.
[2] Mercer JS, EricksonOwens DA, Rabe H. Placental transfusion: may the "force" be with the baby[J]. J Perinatol, 2021,41(6):1495-1504.
[3] Committee opinion No. 684 summary: Delayed umbilical cord clamping after birth[J]. Obstet Gynecol, 2017, 129:232-233.
[4] 刘誉,杨慧霞. 2020年美国妇产科医师协会分娩后延迟脐带结扎的专家共识解读[J]. 中华妇产科杂志, 2021,56(7):515-518.
Li Y,Yang HX. Interpretation of 2020 American College of Obstetricians and Gynecologists Committee Opinion: Delayed umbilical cord clamping after birth[J]. Chin J Obstet Gynecol, 2021, 56(7): 516-518.(in Chinese)
[5] Anup CK, Jeff MS, Jochen E, et al. Early cardiac and cerebral hemodynamics with umbilical cord milking compared with delayed cord clamping in infants born preterm[J]. J Pediatr, 2020, 223:51-56.
[6] Katheria AC, Lakshminrusimha S, Rabe H, et al. Placental transfiision:A review[J]. J Perinatol, 2017, 37(2):105-111.
[7] Simonin A, Safarulla A, Farmer Z, et al. Cut umbilical cord milking: An ineffective method of placental transfusion in preterm infants?[J]. Arch Dis Child Fetal Neonatal Ed, 2020, 33(18):3132-3135.
[8] Panburana P, Odthon T, Pongmee P. The effect of umbilical cord milking compared with delayed cord clamping in term neonates: A randomized controlled trial[J]. Int J Womens Health, 2020, 12:301-306.
[9] 中华医学会儿科学分会新生儿学组. 新生儿高胆红素血症诊断和治疗的专家共识[J].中华儿科杂志, 2014, 52(10):745-748.
[10] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].5版.北京:人民卫生出版社,2019.
Shao XM,Ye HM,Qiu XS.Practice of neonatiology[M].5th ed.Beijing:People′s Medical Publishing House,2019.(in Chinese)
[11] Kuik SJ, Kalteren WS, Mebius MJ, et al. Predicting intestinal recovery after necrotizing enterocolitis in preterm infants[J]. Pediatr Res, 2020, 87(5):903-909.
[12] 中华医学会儿科学分会新生儿学组,中华儿科杂志编辑委员会. 早产儿支气管肺发育不良临床管理专家共识[J].中华儿科杂志,2020, 58(5):358-365.
The Subspecialty Group of Neonatology, the Society of Pediatrics, Chinese Medical Association,the Editorial Board, Chinese Journal of Pediatrics. Expert consensus on clinical management of premature infants with brochopulmonary dysplasia[J]. Chin J Pediatr, 2020,58(5): 358-365.(in Chinese)
[13] Jones JG, Holland BM, HudsonI R, et al. Total circulating red blood cells versus haematocrit as the primary descriptor of oxygen transport by the blood[J]. Br J Haematol, 1990, 76:288-294.
[14] Shao HL, Gao SC, Lu QJ, et al. Effects of delayed cord clamping on neonatal jaundice, phototherapy and early hematological status in term cesarean section[J]. Ital J Pediatr, 2021, 47(1):115.
[15] De BG, Giordano M, De SR, et al. A randomized controlled study of immediate versus delayed umbilical cord clamping in infants born by elective caesarean section[J]. Ital J Pediatr, 2020, 46(1):71.
[16] Ryan MM, Emily F, Shani D, et al. Whole blood volumes associated with milking intact and cut umbilical cords in term newborns[J]. J Perinatol, 2018, 38(3):245-250.
[17] Boere I, Roest AA, Wallace E, et al. Umbilical blood flow patterns directly after birth before delayed cord clamping[J]. Arch Dis Child Fetal Neonatal Ed, 2015, 100:121-125.
[18] Garton T, Hua Y, Xiang J, et al. Challenges for intraventricular hemorrhage research and emerging therapeutic targets[J]. Expert Opin Ther Targets, 2017, 21(12):1111-1122.
[19] Sweta B, Xuxin C, Heather H, et al. Purnahamsi desaioptimal timing and methodology of umbilical cord clamping in preterm infants: A review[J]. Current Pediatrics Reports, 2019, 7(3):90-98.
[20] Qian YY, Ying XX, Wang PX, et al. Early versus delayed umbilical cord clamping on maternal and neonatal outcomes[J]. Arch Gynecol Obstet,2019, 300(3):531-543.
PDF(616 KB)
