Functional echocardiographic evaluation of the effect of placental transfusion in full-term newborns who need resuscitation

Abstract

Background At the time of delivery, newborn babies have to pass through transitional changes in many of their life supporting systems. A more successful transition at the level of the cardiovascular system, hence an overall better transition, could be reached if placental transfusion is implicated. Aim To study the feasibility of doing intact umbilical cord milking (I-UCM) as a method of placental transfusion in term neonates who were born depressed and needed resuscitation and to study its hemodynamic effects using echocardiography. Patients and methods A randomized controlled study involving 66 patients over a period of 6 months was conducted. The studied population was assigned to receiving I-UCM or immediate cord clamping. Laboratory parameters, resuscitation interventions, and finally, functional echocardiographic were studied in both groups. Results It was feasible to perform I-UCM in the delivered babies in the assigned group. Such group was found to have faster time for the first breath (45 vs. 60 s), higher Apgar score (5, 8, 10 vs. 4, 7, 9), and no need for more advanced resuscitation interventions compared with the group with immediate cord clamping. Higher levels of hemoglobin (17.20 vs. 15.85) were noticed with less need to transfusion in the intervention group. Better echocardiographic assessments were shown regarding ejection fraction, tricuspid annular plane systolic excursion, and lower incidence of pulmonary hypertension in the I-UCM group (70 vs. 66%, 1.02 vs. 0.87 cm, and 33.3 vs. 62.5%, respectively). Conclusions The practicality of UCM was easy and feasible in both depressed and nondepressed newborns. UCM as a method for placental does not affect resuscitative measures and results in better cardiac performance in asphyxiated babies.