Physiological-based cord clamping in preterm infants using a new purpose-built resuscitation table: A feasibility study

Emma Brouwer; Ronny Knol; Alex S.N. Vernooij; Thomas Van Den Akker; Patricia E. Vlasman; Frans J.C.M. Klumper; Philip Dekoninck; Graeme R. Polglase; Stuart B. Hooper; Arjan B. Te Pas

doi:10.1136/archdischild-2018-315483

Physiological-based cord clamping in preterm infants using a new purpose-built resuscitation table: A feasibility study

Emma Brouwer^*, Ronny Knol, Alex S.N. Vernooij, Thomas Van Den Akker, Patricia E. Vlasman, Frans J.C.M. Klumper, Philip Dekoninck, Graeme R. Polglase, Stuart B. Hooper, Arjan B. Te Pas

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Objective Physiological-based cord clamping (PBCC) led to a more stable cardiovascular adaptation and better oxygenation in preterm lambs, but in preterm infants, this approach has been challenging. Our aim was to assess the feasibility of PBCC, including patterns of oxygen saturation (SpO 2) and heart rate (HR) during stabilisation in preterm infants using a new purpose-built resuscitation table. Design Observational study. Setting Tertiary referral centre, Leiden University Medical Centre, The Netherlands. Patients Infants born below 35 weeks' gestational age. Interventions Infants were stabilised on a new purpose-built resuscitation table (Concord), provided with standard equipment needed for stabilisation. Cord clamping was performed when the infant was stable (HR >100 bpm, spontaneous breathing on continuous positive airway pressure with tidal volumes >4 mL/kg, SpO 2 ≥25th percentile and fraction of inspired oxygen (FiO 2) <0.4). Results Thirty-seven preterm infants were included; mean (SD) gestational age of 30.9 (2.4) weeks, birth weight 1580 (519) g. PBCC was successful in 33 infants (89.2%) and resulted in median (IQR) cord clamping time of 4:23 (3:00-5:11) min after birth. There were no maternal or neonatal adverse events. In 26/37 infants, measurements were adequate for analysis. HR was 113 (81-143) and 144 (129-155) bpm at 1 min and 5 min after birth. SpO 2 levels were 58%(49%-60%) and 91%(80%-96%)%), while median FiO 2 given was 0.30 (0.30-0.31) and 0.31 (0.25-0.97), respectively. Conclusion PBCC in preterm infants using the Concord is feasible. HR remained stable, and SpO 2 quickly increased with low levels of oxygen supply. Trial registration number NTR6095, results.

Original language	English
Pages (from-to)	F396-F402
Journal	Archives of Disease in Childhood: Fetal and Neonatal Edition
Volume	104
Issue number	4
DOIs	https://doi.org/10.1136/archdischild-2018-315483
Publication status	Published - 1 Jul 2019
Externally published	Yes

Funding

Contributors EB, RK and ABtP wrote the ethics application, participated in the study design and coordination, trained the clinicians, collected and analysed the data and reviewed the literature. ASNV, FJCMK and SBH participated in the study design. EB, RK, ASNV, FJCMK, ABtP, SBH and PEV participated in design and development of the device. EB and RK wrote the first draft and submitted the article. All authors participated in reviewing the data and editing the manuscript. All authors have read and approved the final manuscript. Funding ABtP is recipient of an NWO (Netherlands Organisation for Scientific Research) innovational research incentives scheme (VIDI 91716428). This project was sponsored by the Gisela Thier Fund (Leiden) and the Sophia Children’s Hospital Foundation (Rotterdam).

Funders	Funder number
Nederlandse Organisatie voor Wetenschappelijk Onderzoek
Sophia Children’s Hospital Foundation
Netherlands Organisation for Scientific Research) innovational research incentives scheme	VIDI 91716428

Keywords

circulatory
neonatology
physiology
respiratory
resuscitation

Access to Document

10.1136/archdischild-2018-315483

Persistent URL (handle)

Copy link address

Cite this

Brouwer, E., Knol, R., Vernooij, A. S. N., Van Den Akker, T., Vlasman, P. E., Klumper, F. J. C. M., Dekoninck, P., Polglase, G. R., Hooper, S. B., & Te Pas, A. B. (2019). Physiological-based cord clamping in preterm infants using a new purpose-built resuscitation table: A feasibility study. Archives of Disease in Childhood: Fetal and Neonatal Edition, 104(4), F396-F402. https://doi.org/10.1136/archdischild-2018-315483

@article{dd9e473a62c84188a5128717f73f6bdf,

title = "Physiological-based cord clamping in preterm infants using a new purpose-built resuscitation table: A feasibility study",

abstract = "Objective Physiological-based cord clamping (PBCC) led to a more stable cardiovascular adaptation and better oxygenation in preterm lambs, but in preterm infants, this approach has been challenging. Our aim was to assess the feasibility of PBCC, including patterns of oxygen saturation (SpO 2) and heart rate (HR) during stabilisation in preterm infants using a new purpose-built resuscitation table. Design Observational study. Setting Tertiary referral centre, Leiden University Medical Centre, The Netherlands. Patients Infants born below 35 weeks' gestational age. Interventions Infants were stabilised on a new purpose-built resuscitation table (Concord), provided with standard equipment needed for stabilisation. Cord clamping was performed when the infant was stable (HR >100 bpm, spontaneous breathing on continuous positive airway pressure with tidal volumes >4 mL/kg, SpO 2 ≥25th percentile and fraction of inspired oxygen (FiO 2) <0.4). Results Thirty-seven preterm infants were included; mean (SD) gestational age of 30.9 (2.4) weeks, birth weight 1580 (519) g. PBCC was successful in 33 infants (89.2%) and resulted in median (IQR) cord clamping time of 4:23 (3:00-5:11) min after birth. There were no maternal or neonatal adverse events. In 26/37 infants, measurements were adequate for analysis. HR was 113 (81-143) and 144 (129-155) bpm at 1 min and 5 min after birth. SpO 2 levels were 58%(49%-60%) and 91%(80%-96%)%), while median FiO 2 given was 0.30 (0.30-0.31) and 0.31 (0.25-0.97), respectively. Conclusion PBCC in preterm infants using the Concord is feasible. HR remained stable, and SpO 2 quickly increased with low levels of oxygen supply. Trial registration number NTR6095, results.",

keywords = "circulatory, neonatology, physiology, respiratory, resuscitation",

author = "Emma Brouwer and Ronny Knol and Vernooij, {Alex S.N.} and {Van Den Akker}, Thomas and Vlasman, {Patricia E.} and Klumper, {Frans J.C.M.} and Philip Dekoninck and Polglase, {Graeme R.} and Hooper, {Stuart B.} and {Te Pas}, {Arjan B.}",

year = "2019",

month = jul,

day = "1",

doi = "10.1136/archdischild-2018-315483",

language = "English",

volume = "104",

pages = "F396--F402",

journal = "Archives of Disease in Childhood: Fetal and Neonatal Edition",

issn = "1359-2998",

publisher = "BMJ Publishing Group",

number = "4",

}

Brouwer, E, Knol, R, Vernooij, ASN, Van Den Akker, T, Vlasman, PE, Klumper, FJCM, Dekoninck, P, Polglase, GR, Hooper, SB & Te Pas, AB 2019, 'Physiological-based cord clamping in preterm infants using a new purpose-built resuscitation table: A feasibility study', Archives of Disease in Childhood: Fetal and Neonatal Edition, vol. 104, no. 4, pp. F396-F402. https://doi.org/10.1136/archdischild-2018-315483

TY - JOUR

T1 - Physiological-based cord clamping in preterm infants using a new purpose-built resuscitation table

T2 - A feasibility study

AU - Brouwer, Emma

AU - Knol, Ronny

AU - Vernooij, Alex S.N.

AU - Van Den Akker, Thomas

AU - Vlasman, Patricia E.

AU - Klumper, Frans J.C.M.

AU - Dekoninck, Philip

AU - Polglase, Graeme R.

AU - Hooper, Stuart B.

AU - Te Pas, Arjan B.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Objective Physiological-based cord clamping (PBCC) led to a more stable cardiovascular adaptation and better oxygenation in preterm lambs, but in preterm infants, this approach has been challenging. Our aim was to assess the feasibility of PBCC, including patterns of oxygen saturation (SpO 2) and heart rate (HR) during stabilisation in preterm infants using a new purpose-built resuscitation table. Design Observational study. Setting Tertiary referral centre, Leiden University Medical Centre, The Netherlands. Patients Infants born below 35 weeks' gestational age. Interventions Infants were stabilised on a new purpose-built resuscitation table (Concord), provided with standard equipment needed for stabilisation. Cord clamping was performed when the infant was stable (HR >100 bpm, spontaneous breathing on continuous positive airway pressure with tidal volumes >4 mL/kg, SpO 2 ≥25th percentile and fraction of inspired oxygen (FiO 2) <0.4). Results Thirty-seven preterm infants were included; mean (SD) gestational age of 30.9 (2.4) weeks, birth weight 1580 (519) g. PBCC was successful in 33 infants (89.2%) and resulted in median (IQR) cord clamping time of 4:23 (3:00-5:11) min after birth. There were no maternal or neonatal adverse events. In 26/37 infants, measurements were adequate for analysis. HR was 113 (81-143) and 144 (129-155) bpm at 1 min and 5 min after birth. SpO 2 levels were 58%(49%-60%) and 91%(80%-96%)%), while median FiO 2 given was 0.30 (0.30-0.31) and 0.31 (0.25-0.97), respectively. Conclusion PBCC in preterm infants using the Concord is feasible. HR remained stable, and SpO 2 quickly increased with low levels of oxygen supply. Trial registration number NTR6095, results.

AB - Objective Physiological-based cord clamping (PBCC) led to a more stable cardiovascular adaptation and better oxygenation in preterm lambs, but in preterm infants, this approach has been challenging. Our aim was to assess the feasibility of PBCC, including patterns of oxygen saturation (SpO 2) and heart rate (HR) during stabilisation in preterm infants using a new purpose-built resuscitation table. Design Observational study. Setting Tertiary referral centre, Leiden University Medical Centre, The Netherlands. Patients Infants born below 35 weeks' gestational age. Interventions Infants were stabilised on a new purpose-built resuscitation table (Concord), provided with standard equipment needed for stabilisation. Cord clamping was performed when the infant was stable (HR >100 bpm, spontaneous breathing on continuous positive airway pressure with tidal volumes >4 mL/kg, SpO 2 ≥25th percentile and fraction of inspired oxygen (FiO 2) <0.4). Results Thirty-seven preterm infants were included; mean (SD) gestational age of 30.9 (2.4) weeks, birth weight 1580 (519) g. PBCC was successful in 33 infants (89.2%) and resulted in median (IQR) cord clamping time of 4:23 (3:00-5:11) min after birth. There were no maternal or neonatal adverse events. In 26/37 infants, measurements were adequate for analysis. HR was 113 (81-143) and 144 (129-155) bpm at 1 min and 5 min after birth. SpO 2 levels were 58%(49%-60%) and 91%(80%-96%)%), while median FiO 2 given was 0.30 (0.30-0.31) and 0.31 (0.25-0.97), respectively. Conclusion PBCC in preterm infants using the Concord is feasible. HR remained stable, and SpO 2 quickly increased with low levels of oxygen supply. Trial registration number NTR6095, results.

KW - circulatory

KW - neonatology

KW - physiology

KW - respiratory

KW - resuscitation

UR - http://www.scopus.com/inward/record.url?scp=85054552869&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85054552869&partnerID=8YFLogxK

U2 - 10.1136/archdischild-2018-315483

DO - 10.1136/archdischild-2018-315483

M3 - Article

C2 - 30282674

AN - SCOPUS:85054552869

SN - 1359-2998

VL - 104

SP - F396-F402

JO - Archives of Disease in Childhood: Fetal and Neonatal Edition

JF - Archives of Disease in Childhood: Fetal and Neonatal Edition

IS - 4

ER -

Physiological-based cord clamping in preterm infants using a new purpose-built resuscitation table: A feasibility study

Abstract

Funding

Keywords

Access to Document

Persistent URL (handle)

Other files and links

Fingerprint

Cite this