Abstract
Postnatal adaptation in preterm newborn comprises complex physiological processes that involve significant changes in the circulatory and respiratory system. Increasing hemoglobin level and blood volume following placental transfusion may be of importance in enhancing arterial oxygen content, increasing cardiac output, and improving oxygen delivery. The European consensus on resuscitation of preterm infants recommends delayed cord clamping (DCC) for at least 60 s to promote placenta–fetal transfusion in uncompromised neonates. Recently, published meta-analyses suggest that DCC is associated with fewer infants requiring transfusions for anemia, a lower incidence of intraventricular hemorrhage, and lower risk for necrotizing enterocolitis. Umbilical cord milking (UCM) has the potential to avoid some disadvantages associated with DCC including the increased risk of hypothermia or delay in commencing manual ventilation. UCM represents an active form of blood transfer from placenta to neonate and may have some advantages over DCC. Moreover, both methods are associated with improvement in hemodynamic parameters and blood pressure within first hours after delivery compared to immediate cord clamping. Placental transfusion appears to be beneficial for the preterm uncompromised infant. Further studies are needed to evaluate simultaneous placental transfusion with resuscitation of deteriorating neonates. It would be of great interest for future research to investigate advantages of this approach further and to assess its impact on neonatal outcomes, particularly in extremely preterm infants.
Highlights
Neonatal adaptation is a complex physiological process that involves numerous adaptive changes within several organ systems
Many questions remain unanswered in relation to placental transfusion and its potential hemodynamic effects
umbilical cord milking (UCM) is more likely to be readily complied with than delayed cord clamping (DCC) due to fewer concerns of delaying commencement of care for the preterm neonate, as was evidenced in the recent RCT where 27% of patients assigned to DCC had immediate cord clamping (ICC) performed instead for this reason [25]
Summary
Neonatal adaptation is a complex physiological process that involves numerous adaptive changes within several organ systems. Increasing fetal hemoglobin (Hb) by placental transfusion may be considered a method in enhancing arterial oxygen content, increasing cardiac output, and improving oxygen delivery It involves a shift of placental blood to the neonate within a limited amount of time immediately after delivery and may be achieved in two different ways: delayed cord clamping (DCC) and umbilical cord milking (UCM) [1,2,3]. A number of studies highlight the potential cardiovascular benefits of placental transfusion in preterm infants These include effects on mean BP, administration of volume and inotropes and other objective hemodynamic assessment methods [e.g., superior vena cava (SVC) blood flow, right ventricle output]. There was a trend toward lower rates of severe IVH, for the most preterm infants (22–24 weeks of gestation) [12]
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