Abstract
Background Establishing lung inflation prior to umbilical cord clamping may improve the cardiovascular
transition and reduce the risk of intraventricular hemorrhage in preterm infants.
We developed a pilot feasibility and safety study in which infants < 33 weeks' gestation
received assisted ventilation during delayed cord clamping (DCC).
Methods Infants born between 24 0/7 and 32 6/7 weeks' gestation whose mothers consented were
enrolled. All infants received continuous positive airway pressure or positive pressure
ventilation during 90 seconds of DCC. Outcomes included feasibility (ability to complete
protocol and maintain a sterile field during cesarean deliveries) and safety variables
(Apgar scores, umbilical cord pH and base deficit, admission temperature, and postcesarean
infection).
Results A total of 29 infants were enrolled, including one set of twins (median gestation:
30 weeks; 72% cesarean births). In all cases, the protocol was completed. Heart rate
at 60 seconds was more than 100 beats per minute in all infants. Apgar scores, cord
blood gas values, and admission temperature were comparable to other preterm deliveries
at our institution.
Conclusion Assisting ventilation of very preterm infants during 90 seconds of DCC is challenging
but feasible and appears to be safe in this small pilot study. A randomized clinical
trial is warranted to determine clinical benefit.
Keywords
delayed cord clamping - prematurity - intraventricular hemorrhage - resuscitation
