Am J Perinatol
DOI: 10.1055/s-0043-1775563
Original Article

Supine versus Prone Position during Delayed Cord Clamping in Infants ≥36 Weeks: A Randomized Trial

Brahim Bensouda
1   Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
,
Romain Mandel
1   Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
,
Abdelwaheb Mejri
1   Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
,
Laurent Tordjman
2   Department of Obstetrics and Gynecology, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
,
Marie St-Hilaire
1   Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
,
Nabeel Ali
1   Department of Pediatrics, Maisonneuve-Rosemont Hospital and University of Montreal, Montréal, Quebec, Canada
› Author Affiliations
Funding No external funding for this manuscript. INVOS System was loaned for the duration of the study, and disposable sensors were provided free of charge by Medtronic Canada.

Abstract

Objective There is no recommendation in the literature on optimal positioning of the newborn immediately at birth during delayed cord clamping. To evaluate if prone positioning on the mother's chest at birth during delayed cord clamping leads to a higher hematocrit at 30 hours of life compared to supine positioning.

Study Design A randomized unblinded trial comparing prone and supine position of the newborn before umbilical cord clamping. Healthy newborns ≥36 weeks gestational age and born vaginally with cephalic presentation were included. The newborn was randomized to prone or supine position. Umbilical cord clamping was delayed in both groups to 1 minute after birth. The primary outcome was hematocrit at 30 hours of life. As a secondary outcome, cerebral tissue oxygenation (CrSO2) values were compared between both groups by near infrared spectroscopy.

Results There was no difference in hematocrit at 30 hours of life between supine and prone positions with a mean at 52 and 53.1, respectively, mean difference −1.1 (95% confidence interval:−2.7, 0.5), p = 0.17. Newborns in supine and prone positions had comparable level of CrSO2 at 30 hours of life with a mean at 84.1 and 82.2, respectively, mean difference 1.9 (−0.2, 4.0), p = 0.07. There was no correlation between hematocrit and CrSO2 at 30 hours of life (r = 0.14).

Conclusion There was no difference between prone and supine positioning immediately after birth during delayed cord clamping on hematocrit at 30 hours of life. In the absence of clear findings, further studies with assessment of the effect of position on breastfeeding success in the case room, on maternal satisfaction and outcome beyond 30 hours are needed to make adequate recommendations on positioning.

Key Points

  • Delayed cord clamping at 60 seconds is recommended at birth, but optimal positioning is unknown.

  • A randomized trial was conducted to compare hematocrit at 36 hours of life of prone versus supine position.

  • No difference in hematocrit was found in prone versus supine position during delayed cord clamping.

Clinical Trial Registry Name and Registration Number

This study is registed as supine versus prone position at birth before cord clamping (identifier: NCT03697967).


Data Availability Statement

Deidentified individual participant data will be made available to researchers who make a methodologically sound proposal. Proposals should be submitted to brahim.bensouda@umontreal.ca.


Authors' Contributions

B.B. and N.A. conceptualized and designed the study, obtained the parents' consents, collected data, drafted the initial manuscript, reviewed and revised the manuscript. L.T., M.S., and A.M. conceptualized and reviewed the manuscript for important intellectual content. R.M. conceptualized, designed the study, and reviewed the manuscript for important intellectual content. All the authors approved the final manuscript as submitted and agreed to be accountable for all aspects of work.




Publication History

Received: 16 February 2023

Accepted: 22 August 2023

Article published online:
19 September 2023

© 2023. Thieme. All rights reserved.

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  • References

  • 1 Committee on Obstetric Practice, American College of Obstetricians and Gynecologists. Committee Opinion No. 543: Timing of umbilical cord clamping after birth. Obstet Gynecol 2017; 120 (06) 1522-1526
  • 2 McDonald SD, Narvey M, Ehman W, Jain V, Cassell K. Guideline No. 424: Umbilical cord management in preterm and term infants. J Obstet Gynaecol Can 2022; 44 (03) 313-322.e1
  • 3 Grajeda R, Pérez-Escamilla R, Dewey KG. Delayed clamping of the umbilical cord improves hematologic status of Guatemalan infants at 2 mo of age. Am J Clin Nutr 1997; 65 (02) 425-431
  • 4 Rabe H, Mercer J, Erickson-Owens D. Correction to: What does the evidence tell us? Revisiting optimal cord management at the time of birth. Eur J Pediatr 2022; 181 (05) 1809
  • 5 Redmond A, Isana S, Ingall D. Relation of onset of respiration to placental transfusion. Lancet 1965; 1 (7380) 283-285
  • 6 Adams JA, Zabaleta IA, Sackner MA. Comparison of supine and prone noninvasive measurements of breathing patterns in fullterm newborns. Pediatr Pulmonol 1994; 18 (01) 8-12
  • 7 Ceriani Cernadas JM, Carroli G, Pellegrini L. et al. The effect of timing of cord clamping on neonatal venous hematocrit values and clinical outcome at term: a randomized, controlled trial. Pediatrics 2006; 117 (04) e779-e786
  • 8 Maastrup R, Hannula L, Hansen MN, Ezeonodo A, Haiek LN. The Baby-friendly Hospital Initiative for neonatal wards. A mini review. Acta Paediatr 2022; 111 (04) 750-755
  • 9 Miller-Barmak A, Riskin A, Hochwald O. et al. Oxygenation instability assessed by oxygen saturation histograms during supine vs prone position in very low birthweight infants receiving noninvasive respiratory support. J Pediatr 2020; 226: 123-128
  • 10 Havranek T, Shatzkin E, Chuang M, Xie X, Kim M, Rosen O. Respiratory outcomes after neonatal prone versus supine positioning following scheduled cesarean delivery: a randomized trial. J Matern Fetal Neonatal Med 2021; 34 (18) 2938-2944