Oxygen saturation and heart rate in healthy term and late preterm infants with delayed cord clamping.

Inmaculada Lara-Cantón,Calum Roberts,Arjan Te Pas,Shiraz Badurdeen,Máximo Vento,Peter Davis,Janneke Dekker

doi:10.1038/s41390-021-01805-y

Inmaculada Lara-Cantón, Calum Roberts + Show 5 more

Open Access

https://doi.org/10.1038/s41390-021-01805-y

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Abstract

Blood oxygen in the fetus is substantially lower than in the newborn infant. In the minutes after birth, arterial oxygen saturation rises from around 50-60% to 90-95%. Initial respiratory efforts generate negative trans-thoracic pressures that drive liquid from the airways into the lung interstitium facilitating lung aeration, blood oxygenation, and pulmonary artery vasodilatation. Consequently, intra- (foramen ovale) and extra-cardiac (ductus arteriosus) shunting changes and the sequential circulation switches to a parallel pulmonary and systemic circulation. Delaying cord clamping preserves blood flow through the ascending vena cava, thus increasing right and left ventricular preload. Recently published reference ranges have suggested that delayed cord clamping positively influenced the fetal-to-neonatal transition. Oxygen saturation in babies with delayed cord clamping plateaus significantly earlier to values of 85-90% than in babies with immediate cord clamping. Delayed cord clamping may also contribute to fewer episodes of brady-or-tachycardia in the first minutes after birth, but data from randomized trials are awaited. IMPACT: Delaying cord clamping during fetal to neonatal transition contributes to a significantly earlier plateauing of oxygen saturation and fewer episodes of brady-and/or-tachycardia in the first minutes after birth. We provide updated information regarding the changes in SpO2 and HR during postnatal adaptation of term and late preterm infants receiving delayed compared with immediate cord clamping. Nomograms in newborn infants with delayed cord clamping will provide valuable reference ranges to establish target SpO2 and HR in the first minutes after birth.

Highlights

To objectively guide resuscitation, monitoring of arterial oxygen saturation (SpO2) and heart rate (HR) using pulse oximetry has become standard of care.[1,2,3] In 2010, Dawson et al.[4,5], merging three databases from the Royal Women’s Hospital (Melbourne) and the University and Polytechnic Hospital La Fe (Valencia), established a reference range for SpO2 and HR
● We provide updated information regarding the changes in SpO2 and HR during postnatal adaptation of term and late preterm infants receiving delayed compared with immediate cord clamping
Oxygen provided to fetal tissues is equivalent to that supplying the newborn infant due to metabolic and cardiocirculatory adjustments

Summary

INTRODUCTION

OF PULSE OXIMETRY MONITORING IN THE DELIVERY ROOM For many years, evaluation of the condition of the newborn infant in the first minutes of life was based on clinical signs including HR. Section, allocating them to either ICC, or DCC of at least 60 s This observation has contributed to an ongoing body of work Cavallin et al.[46] included 80 infants and did not identify a aimed at establishing whether delaying cord clamping would provide greater physiological stability during fetal-to-neonatal transition.[39,40] Additional comparisons of infant HR measured significant difference in either SpO2 or HR in the first 10 min after birth. Dawson’s nomogram for et al.[49] reproduced with permission of The Journal of Pediatrics

Lara-Cantón et al 4

CONCLUSIONS

Findings

FUNDING INFORMATION