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American Academy of Pediatrics
Article

Neonatal Outcome Following Cord Clamping After Onset of Spontaneous Respiration

Hege Langli Ersdal, Jørgen Linde, Estomih Mduma, Bjørn Auestad and Jeffrey Perlman
Pediatrics August 2014, 134 (2) 265-272; DOI: https://doi.org/10.1542/peds.2014-0467
Hege Langli Ersdal
aDepartment of Anesthesiology and Intensive Care, and
bSAFER (Stavanger Acute medicine Foundation for Education and Research), Stavanger University Hospital, Norway; Departments of
cHealth Studies, and
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Jørgen Linde
bSAFER (Stavanger Acute medicine Foundation for Education and Research), Stavanger University Hospital, Norway; Departments of
cHealth Studies, and
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Estomih Mduma
bSAFER (Stavanger Acute medicine Foundation for Education and Research), Stavanger University Hospital, Norway; Departments of
cHealth Studies, and
dDepartment of Research, Haydom Lutheran Hospital, Haydom, Tanzania; and
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Bjørn Auestad
eMathematics and Natural Sciences, University of Stavanger, Norway;
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Jeffrey Perlman
fDepartment of Pediatrics, Weill Cornell Medical College, New York, New York
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Abstract

BACKGROUND AND OBJECTIVE: Evolving data indicate that cord clamping (CC) beyond 30 to 60 seconds after birth is of benefit for all infants. Recent experimental data demonstrated that ventilation before CC improved cardiovascular stability by increasing pulmonary blood flow. The objective was to describe the relationship between time to CC, onset of spontaneous respirations (SR), and 24-hour neonatal outcome.

METHODS: In a rural Tanzanian hospital, trained research assistants, working in shifts, have observed every delivery (November 2009–February 2013) and recorded data including time interval from birth to SR and CC, fetal heart rate, perinatal characteristics and outcome (normal, death, admission).

RESULTS: Of 15 563 infants born, 12 780 (84.3%) initiated SR at 10.8 ± 16.7 seconds, and CC occurred at 63 ± 45 seconds after birth. Outcomes included 12 730 (99.7%) normal, 31 deaths, and 19 admitted; 11 967 were of birth weight (BW) ≥2500 g and 813 <2500 g. By logistic modeling, the risk of death/admission was consistently higher if CC occurred before SR. Infants of BW <2500 g were more likely to die or be admitted. The risk of death/admission decreased by 20% for every 10-second delay in CC after SR; this risk declined at the same rate in both BW groups.

CONCLUSIONS: Healthy self-breathing neonates are more likely to die or be admitted if CC occurs before or immediately after onset of SR. These clinical observations support the experimental findings of a smoother cardiovascular transition when CC is performed after initiation of ventilation.

  • cord clamping
  • neonatal mortality and morbidity
  • Accepted May 7, 2014.
  • Copyright © 2014 by the American Academy of Pediatrics

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Pediatrics
Vol. 134, Issue 2
1 Aug 2014
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Neonatal Outcome Following Cord Clamping After Onset of Spontaneous Respiration
Hege Langli Ersdal, Jørgen Linde, Estomih Mduma, Bjørn Auestad, Jeffrey Perlman
Pediatrics Aug 2014, 134 (2) 265-272; DOI: 10.1542/peds.2014-0467

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Neonatal Outcome Following Cord Clamping After Onset of Spontaneous Respiration
Hege Langli Ersdal, Jørgen Linde, Estomih Mduma, Bjørn Auestad, Jeffrey Perlman
Pediatrics Aug 2014, 134 (2) 265-272; DOI: 10.1542/peds.2014-0467
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