Published online March 1, 2007
PEDIATRICS Vol. 119 No. 3 March 2007, pp. 455-459 (doi:10.1542/peds.2006-2725)
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ARTICLE

The Influence of the Timing of Cord Clamping on Postnatal Cerebral Oxygenation in Preterm Neonates: A Randomized, Controlled Trial

Oskar Baenziger, MD, Florian Stolkin, MD, Mathias Keel, RN, Kurt von Siebenthal, MD, Jean-Claude Fauchere, MD, Seema Das Kundu, MD, Vera Dietz, MD, Hans-Ulrich Bucher, MD and Martin Wolf, PhD

Department of Neonatology, University Hospital Zurich, Zurich, Switzerland

OBJECTIVE. Our goal was to investigate the effect of placentofetal transfusion on cerebral oxygenation in preterm infants by near-infrared spectroscopy.

SUBJECTS. A total of 39 preterm infants with a median gestational age of 30.4 weeks were randomly assigned to an experiment group (n = 15) and a control group (n = 24).

INTERVENTIONS. The delivery of the infants in the experiment group was immediately followed by maternal administration of syntocinon, the infant was placed 15 cm below the placenta, and cord clamping was delayed by 60 to 90 seconds. The infants in the control group were delivered conventionally. At the ages of 4 and 24 hours, cerebral hemoglobin concentrations, cerebral blood volume, and regional tissue oxygenation were measured by near-infrared spectroscopy.

RESULTS. Cerebral blood volume was not different between the 2 groups at the age of 4 hours (6.1 vs 5.8 mL/100 g of tissue) nor at the age of 24 hours (6.2 vs 6.2 mL/100 g of tissue). Mean regional tissue oxygenation of the experiment group was higher at the ages of 4 hours (69.9% vs 65.5%) and of 24 hours (71.3% vs 68.1%).

CONCLUSION. Delayed clamping of the umbilical cord improves cerebral oxygenation in preterm infants in the first 24 hours.

Key Words: blood transfusion • infant • neonatal brain injury • prematurity • umbilical cord clamping

Abbreviations: PFT—placento-fetal transfusion • NIRS— near-infrared spectroscopy • tHb—total hemoglobin • StO2— regional tissue oxygen saturation • CBV— cerebral blood volume

Accepted Nov 10, 2006.


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eLetters:

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Of clinical significance and varying variability
Mathieu Lemaire
Pediatrics Online, 3 Oct 2007 [Full text]