Optimizing Placental Transfusion for Preterm Infants.

Abstract

* Abbreviations: ACOG — : American College of Obstetricians and Gynecologists DCC — : delayed umbilical cord clamping ICC — : immediate cord clamping IVH — : intraventricular hemorrhage UCM — : umbilical cord milking There are many potential benefits of delayed or deferred cord clamping (DCC) compared with immediate cord clamping (ICC).1 Increasing placental transfusion by DCC increases neonatal blood volume and improves transitional hemodynamics. DCC may also increase iron stores, reducing childhood anemia and increasing the transfer of stem cells, which may have antiinflammatory neurotropic and neuroprotective effects. The American College of Obstetricians and Gynecologists (ACOG) gives conditional support for a 30- to 60-second delay in umbilical cord clamping (DCC) for all preterm infants.2 To a great degree, the ACOG opinion piece was informed by the meta-analysis of Rabe et al,3 which analyzed the results from 15 eligible studies that enrolled 738 premature infants born between 24 and 36 weeks’ gestation. DCC was associated with fewer infants needing transfusion for anemia or low blood pressure and less intraventricular hemorrhage (IVH). However, no differences were noted in severe IVH, periventricular leukomalacia, mortality, or neurodevelopmental follow-up. The ACOG opinion qualifies its support by noting that many aspects of DCC need additional study.2 Little is … Address correspondence to Roger F. Soll, MD, Department of Pediatrics, University of Vermont Medical Center, 111 Colchester Ave, Burlington, VT 05401. E-mail: roger.soll{at}uvmhealth.org